|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$12,163.50 |
| Rate for Payer: Aetna Commercial |
$10,947.15
|
| Rate for Payer: Aetna Medicare |
$3,162.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: ASR ASR |
$11,798.59
|
| Rate for Payer: ASR Commercial |
$11,798.59
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCBS Trust/PPO |
$9,960.69
|
| Rate for Payer: BCN Commercial |
$9,430.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$11,433.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$12,163.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,798.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,162.90
|
| Rate for Payer: Mclaren Commercial |
$10,947.15
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Commercial |
$3,479.19
|
| Rate for Payer: PHP Medicaid |
$1,695.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,657.66
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health Narrow Network |
$8,526.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,703.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$4,902.49
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP DNSP |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,906.27 |
| Max. Negotiated Rate |
$12,163.50 |
| Rate for Payer: Aetna Commercial |
$10,947.15
|
| Rate for Payer: ASR ASR |
$11,798.59
|
| Rate for Payer: ASR Commercial |
$11,798.59
|
| Rate for Payer: BCBS Trust/PPO |
$9,912.04
|
| Rate for Payer: BCN Commercial |
$9,430.36
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$11,433.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Healthscope Commercial |
$12,163.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,798.59
|
| Rate for Payer: Mclaren Commercial |
$10,947.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,703.88
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$28.92
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: ASR ASR |
$31.17
|
| Rate for Payer: ASR Commercial |
$31.17
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Trust/PPO |
$26.31
|
| Rate for Payer: BCN Commercial |
$24.91
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.17
|
| Rate for Payer: Mclaren Commercial |
$28.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.15
|
| Rate for Payer: Priority Health Narrow Network |
$22.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$28.92
|
| Rate for Payer: ASR ASR |
$31.17
|
| Rate for Payer: ASR Commercial |
$31.17
|
| Rate for Payer: BCBS Trust/PPO |
$26.18
|
| Rate for Payer: BCN Commercial |
$24.91
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.17
|
| Rate for Payer: Mclaren Commercial |
$28.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Aetna Commercial |
$39.93
|
| Rate for Payer: ASR ASR |
$43.04
|
| Rate for Payer: ASR Commercial |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$36.16
|
| Rate for Payer: BCN Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$44.37
|
| Rate for Payer: Healthscope Whirlpool |
$43.04
|
| Rate for Payer: Mclaren Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.05
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Aetna Commercial |
$39.93
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: ASR ASR |
$43.04
|
| Rate for Payer: ASR Commercial |
$43.04
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$36.33
|
| Rate for Payer: BCN Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$44.37
|
| Rate for Payer: Healthscope Whirlpool |
$43.04
|
| Rate for Payer: Mclaren Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.88
|
| Rate for Payer: Priority Health Narrow Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.05
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.65
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.53
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.65
|
| Rate for Payer: Priority Health Narrow Network |
$110.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$102.11 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Trust/PPO |
$128.02
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.53
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| 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 |
$84.10
|
| Rate for Payer: ASR Commercial |
$84.10
|
| Rate for Payer: BCBS Complete |
$13.57
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$71.00
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$81.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.70
|
| Rate for Payer: Healthscope Whirlpool |
$84.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| 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 |
$13.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.69
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| 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 |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.97
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$60.78
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP DNSP |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: ASR ASR |
$84.10
|
| Rate for Payer: ASR Commercial |
$84.10
|
| Rate for Payer: BCBS Trust/PPO |
$70.65
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$81.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Healthscope Commercial |
$86.70
|
| Rate for Payer: Healthscope Whirlpool |
$84.10
|
| Rate for Payer: Mclaren Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.69
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: ASR ASR |
$115.40
|
| Rate for Payer: ASR Commercial |
$115.40
|
| Rate for Payer: BCBS Complete |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$97.42
|
| Rate for Payer: BCN Commercial |
$92.24
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$111.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Healthscope Whirlpool |
$115.40
|
| Rate for Payer: Mclaren Commercial |
$107.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.24
|
| Rate for Payer: Priority Health Narrow Network |
$83.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.69
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: ASR ASR |
$115.40
|
| Rate for Payer: ASR Commercial |
$115.40
|
| Rate for Payer: BCBS Trust/PPO |
$96.95
|
| Rate for Payer: BCN Commercial |
$92.24
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$111.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Healthscope Whirlpool |
$115.40
|
| Rate for Payer: Mclaren Commercial |
$107.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.69
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: ASR ASR |
$72.46
|
| Rate for Payer: ASR Commercial |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$60.87
|
| Rate for Payer: BCN Commercial |
$57.91
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Healthscope Whirlpool |
$72.46
|
| Rate for Payer: Mclaren Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.74
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Aetna Medicare |
$37.35
|
| Rate for Payer: ASR ASR |
$72.46
|
| Rate for Payer: ASR Commercial |
$72.46
|
| Rate for Payer: BCBS Complete |
$29.88
|
| Rate for Payer: BCBS Trust/PPO |
$61.17
|
| Rate for Payer: BCN Commercial |
$57.91
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Healthscope Whirlpool |
$72.46
|
| Rate for Payer: Mclaren Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.45
|
| Rate for Payer: Priority Health Narrow Network |
$52.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.74
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.77 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: Aetna Medicare |
$352.21
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: ASR Commercial |
$683.29
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: BCBS Trust/PPO |
$576.85
|
| Rate for Payer: BCN Commercial |
$546.14
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$704.42
|
| Rate for Payer: Healthscope Whirlpool |
$683.29
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.21
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$457.87 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: ASR Commercial |
$683.29
|
| Rate for Payer: BCBS Trust/PPO |
$574.03
|
| Rate for Payer: BCN Commercial |
$546.14
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$704.42
|
| Rate for Payer: Healthscope Whirlpool |
$683.29
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$86.43 |
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: ASR ASR |
$83.84
|
| Rate for Payer: ASR Commercial |
$83.84
|
| Rate for Payer: BCBS Trust/PPO |
$70.43
|
| Rate for Payer: BCN Commercial |
$67.01
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$81.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$86.43
|
| Rate for Payer: Healthscope Whirlpool |
$83.84
|
| Rate for Payer: Mclaren Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.06
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
OP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$86.43 |
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: Aetna Medicare |
$43.22
|
| Rate for Payer: ASR ASR |
$83.84
|
| Rate for Payer: ASR Commercial |
$83.84
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: BCBS Trust/PPO |
$70.78
|
| Rate for Payer: BCN Commercial |
$67.01
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$81.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$86.43
|
| Rate for Payer: Healthscope Whirlpool |
$83.84
|
| Rate for Payer: Mclaren Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.73
|
| Rate for Payer: Priority Health Narrow Network |
$60.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.06
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
IP
|
$58.65
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$56.89
|
| Rate for Payer: ASR Commercial |
$56.89
|
| Rate for Payer: BCBS Trust/PPO |
$47.79
|
| Rate for Payer: BCN Commercial |
$45.47
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Healthscope Commercial |
$58.65
|
| Rate for Payer: Healthscope Whirlpool |
$56.89
|
| Rate for Payer: Mclaren Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.61
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| 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 |
$56.89
|
| Rate for Payer: ASR Commercial |
$56.89
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$48.03
|
| Rate for Payer: BCN Commercial |
$45.47
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$58.65
|
| Rate for Payer: Healthscope Whirlpool |
$56.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.48
|
| Rate for Payer: Mclaren Commercial |
$52.78
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| 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 |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| 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 |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.39
|
| Rate for Payer: Priority Health Medicare |
$7.48
|
| Rate for Payer: Priority Health Narrow Network |
$41.11
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.48
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Medicare Advantage |
$7.48
|
| Rate for Payer: UHCCP DNSP |
$7.48
|
| Rate for Payer: UHCCP Medicaid |
$4.01
|
| Rate for Payer: VA VA |
$7.48
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
IP
|
$32.77
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: ASR Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$26.70
|
| Rate for Payer: BCN Commercial |
$25.41
|
| 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 |
$32.77
|
| Rate for Payer: Healthscope Whirlpool |
$31.79
|
| 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: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
OP
|
$32.77
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| 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 |
$31.79
|
| Rate for Payer: ASR Commercial |
$31.79
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$26.84
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$26.22
|
| 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: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Healthscope Whirlpool |
$31.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| 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 |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Nomi Health Commercial |
$26.87
|
| 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 |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.71
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$22.97
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP DNSP |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$80.58 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| 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 |
$78.16
|
| Rate for Payer: ASR Commercial |
$78.16
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$8.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.99
|
| Rate for Payer: BCN Commercial |
$62.47
|
| Rate for Payer: BCN Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.65
|
| Rate for Payer: Healthscope Commercial |
$80.58
|
| Rate for Payer: Healthscope Whirlpool |
$78.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.65
|
| Rate for Payer: Mclaren Commercial |
$72.52
|
| Rate for Payer: Mclaren Medicaid |
$4.64
|
| 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 |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| 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 |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.60
|
| Rate for Payer: Priority Health Medicare |
$8.65
|
| Rate for Payer: Priority Health Narrow Network |
$56.49
|
| Rate for Payer: Railroad Medicare Medicare |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.65
|
| Rate for Payer: UHC Exchange |
$13.41
|
| Rate for Payer: UHC Medicare Advantage |
$8.65
|
| Rate for Payer: UHCCP DNSP |
$8.65
|
| Rate for Payer: UHCCP Medicaid |
$4.64
|
| Rate for Payer: VA VA |
$8.65
|
|
