|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Aetna Medicare |
$146.70
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$573.80
|
| Rate for Payer: Priority Health Narrow Network |
$459.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
IP
|
$705.75
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$529.31 |
| Max. Negotiated Rate |
$705.75 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: ASR ASR |
$684.58
|
| Rate for Payer: BCBS Trust/PPO |
$579.56
|
| Rate for Payer: BCN Commercial |
$579.56
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cofinity Commercial |
$663.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.60
|
| Rate for Payer: Healthscope Commercial |
$684.58
|
| Rate for Payer: Healthscope Whirlpool |
$705.75
|
| Rate for Payer: Mclaren Commercial |
$635.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.89
|
| Rate for Payer: Nomi Health Commercial |
$578.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$621.06
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
OP
|
$705.75
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$705.75 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$684.58
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$581.89
|
| Rate for Payer: BCN Commercial |
$581.89
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cofinity Commercial |
$663.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$684.58
|
| Rate for Payer: Healthscope Whirlpool |
$705.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$635.17
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.89
|
| Rate for Payer: Nomi Health Commercial |
$578.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.31
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$618.38
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$494.73
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$621.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC US OB FU
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.79 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Trust/PPO |
$407.09
|
| Rate for Payer: BCN Commercial |
$407.09
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
|
|
HC US OB FU
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.72
|
| Rate for Payer: BCN Commercial |
$408.72
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.03
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$241.63
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
IP
|
$593.63
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$445.22 |
| Max. Negotiated Rate |
$593.63 |
| Rate for Payer: Aetna Commercial |
$534.27
|
| Rate for Payer: ASR ASR |
$575.82
|
| Rate for Payer: BCBS Trust/PPO |
$487.49
|
| Rate for Payer: BCN Commercial |
$487.49
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Commercial |
$558.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Healthscope Commercial |
$575.82
|
| Rate for Payer: Healthscope Whirlpool |
$593.63
|
| Rate for Payer: Mclaren Commercial |
$534.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.59
|
| Rate for Payer: Nomi Health Commercial |
$486.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.39
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
OP
|
$593.63
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$593.63 |
| Rate for Payer: Aetna Commercial |
$534.27
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$575.82
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$489.45
|
| Rate for Payer: BCN Commercial |
$489.45
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Commercial |
$558.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$575.82
|
| Rate for Payer: Healthscope Whirlpool |
$593.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$534.27
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.59
|
| Rate for Payer: Nomi Health Commercial |
$486.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$516.31
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$413.04
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
OP
|
$593.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$593.50 |
| Rate for Payer: Aetna Commercial |
$534.15
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$575.70
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$489.34
|
| Rate for Payer: BCN Commercial |
$489.34
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$474.80
|
| Rate for Payer: Cash Price |
$474.80
|
| Rate for Payer: Cofinity Commercial |
$557.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$575.70
|
| Rate for Payer: Healthscope Whirlpool |
$593.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$534.15
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.48
|
| Rate for Payer: Nomi Health Commercial |
$486.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.12
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.36
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$344.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
IP
|
$593.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$445.12 |
| Max. Negotiated Rate |
$593.50 |
| Rate for Payer: Aetna Commercial |
$534.15
|
| Rate for Payer: ASR ASR |
$575.70
|
| Rate for Payer: BCBS Trust/PPO |
$487.38
|
| Rate for Payer: BCN Commercial |
$487.38
|
| Rate for Payer: Cash Price |
$474.80
|
| Rate for Payer: Cofinity Commercial |
$557.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.80
|
| Rate for Payer: Healthscope Commercial |
$575.70
|
| Rate for Payer: Healthscope Whirlpool |
$593.50
|
| Rate for Payer: Mclaren Commercial |
$534.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.48
|
| Rate for Payer: Nomi Health Commercial |
$486.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.28
|
|
|
HC US OB LTD
|
Facility
|
OP
|
$495.83
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$495.83 |
| Rate for Payer: Aetna Commercial |
$446.25
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$480.96
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.81
|
| Rate for Payer: BCN Commercial |
$408.81
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$466.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$495.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$446.25
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.46
|
| Rate for Payer: Nomi Health Commercial |
$406.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.87
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.03
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$241.63
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB LTD
|
Facility
|
IP
|
$495.83
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.87 |
| Max. Negotiated Rate |
$495.83 |
| Rate for Payer: Aetna Commercial |
$446.25
|
| Rate for Payer: ASR ASR |
$480.96
|
| Rate for Payer: BCBS Trust/PPO |
$407.18
|
| Rate for Payer: BCN Commercial |
$407.18
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$466.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.66
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$495.83
|
| Rate for Payer: Mclaren Commercial |
$446.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.46
|
| Rate for Payer: Nomi Health Commercial |
$406.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.33
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$180.02 |
| Rate for Payer: Aetna Commercial |
$162.02
|
| Rate for Payer: ASR ASR |
$174.62
|
| Rate for Payer: BCBS Trust/PPO |
$147.83
|
| Rate for Payer: BCN Commercial |
$147.83
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Healthscope Commercial |
$174.62
|
| Rate for Payer: Healthscope Whirlpool |
$180.02
|
| Rate for Payer: Mclaren Commercial |
$162.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Nomi Health Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.42
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$405.53 |
| Rate for Payer: Aetna Commercial |
$162.02
|
| Rate for Payer: Aetna Medicare |
$66.61
|
| Rate for Payer: ASR ASR |
$174.62
|
| Rate for Payer: BCBS Complete |
$72.01
|
| Rate for Payer: BCBS Trust/PPO |
$148.43
|
| Rate for Payer: BCN Commercial |
$148.43
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Healthscope Commercial |
$174.62
|
| Rate for Payer: Healthscope Whirlpool |
$180.02
|
| Rate for Payer: Mclaren Commercial |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Nomi Health Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$405.53
|
| Rate for Payer: Priority Health Narrow Network |
$324.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.42
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.67 |
| Max. Negotiated Rate |
$467.56 |
| Rate for Payer: Aetna Commercial |
$420.80
|
| Rate for Payer: ASR ASR |
$453.53
|
| Rate for Payer: BCBS Trust/PPO |
$383.96
|
| Rate for Payer: BCN Commercial |
$383.96
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Commercial |
$439.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Healthscope Commercial |
$453.53
|
| Rate for Payer: Healthscope Whirlpool |
$467.56
|
| Rate for Payer: Mclaren Commercial |
$420.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Nomi Health Commercial |
$383.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.45
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$530.22 |
| Rate for Payer: Aetna Commercial |
$420.80
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$453.53
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$385.50
|
| Rate for Payer: BCN Commercial |
$385.50
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Commercial |
$439.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$453.53
|
| Rate for Payer: Healthscope Whirlpool |
$467.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$420.80
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Nomi Health Commercial |
$383.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$530.22
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$424.17
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.68 |
| Max. Negotiated Rate |
$406.24 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: ASR ASR |
$394.05
|
| Rate for Payer: BCBS Trust/PPO |
$333.60
|
| Rate for Payer: BCN Commercial |
$333.60
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Commercial |
$381.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Healthscope Commercial |
$394.05
|
| Rate for Payer: Healthscope Whirlpool |
$406.24
|
| Rate for Payer: Mclaren Commercial |
$365.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Nomi Health Commercial |
$333.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.49
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$430.36 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$394.05
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$334.94
|
| Rate for Payer: BCN Commercial |
$334.94
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Commercial |
$381.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$394.05
|
| Rate for Payer: Healthscope Whirlpool |
$406.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$365.62
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Nomi Health Commercial |
$333.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.36
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$344.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$833.09 |
| Max. Negotiated Rate |
$1,110.78 |
| Rate for Payer: Aetna Commercial |
$999.70
|
| Rate for Payer: ASR ASR |
$1,077.46
|
| Rate for Payer: BCBS Trust/PPO |
$912.17
|
| Rate for Payer: BCN Commercial |
$912.17
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Commercial |
$1,044.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Healthscope Commercial |
$1,077.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.78
|
| Rate for Payer: Mclaren Commercial |
$999.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Nomi Health Commercial |
$910.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.49
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$1,110.78 |
| Rate for Payer: Aetna Commercial |
$999.70
|
| Rate for Payer: Aetna Medicare |
$201.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: ASR ASR |
$1,077.46
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$915.84
|
| Rate for Payer: BCN Commercial |
$915.84
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Commercial |
$1,044.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$1,077.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$201.44
|
| Rate for Payer: Mclaren Commercial |
$999.70
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$110.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Nomi Health Commercial |
$910.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$221.58
|
| Rate for Payer: PHP Medicaid |
$107.97
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$973.27
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$778.66
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$312.23
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP DNSP |
$201.44
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$1,653.61 |
| Rate for Payer: Aetna Commercial |
$1,293.72
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$1,394.35
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.19
|
| Rate for Payer: BCN Commercial |
$1,185.19
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Commercial |
$1,351.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,394.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$1,293.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Nomi Health Commercial |
$1,178.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,653.61
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,322.89
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,264.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$1,400.77
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.10 |
| Max. Negotiated Rate |
$1,437.47 |
| Rate for Payer: Aetna Commercial |
$1,293.72
|
| Rate for Payer: ASR ASR |
$1,394.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.45
|
| Rate for Payer: BCN Commercial |
$1,180.45
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Commercial |
$1,351.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Healthscope Commercial |
$1,394.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.47
|
| Rate for Payer: Mclaren Commercial |
$1,293.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Nomi Health Commercial |
$1,178.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,264.97
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.45 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Aetna Commercial |
$468.54
|
| Rate for Payer: ASR ASR |
$504.98
|
| Rate for Payer: BCBS Trust/PPO |
$427.52
|
| Rate for Payer: BCN Commercial |
$427.52
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$489.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$504.98
|
| Rate for Payer: Healthscope Whirlpool |
$520.60
|
| Rate for Payer: Mclaren Commercial |
$468.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.13
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Aetna Commercial |
$468.54
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$504.98
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$429.23
|
| Rate for Payer: BCN Commercial |
$429.23
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$489.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$504.98
|
| Rate for Payer: Healthscope Whirlpool |
$520.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$468.54
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$287.63
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$843.37
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$908.97
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$772.62
|
| Rate for Payer: BCN Commercial |
$772.62
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$908.97
|
| Rate for Payer: Healthscope Whirlpool |
$937.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$843.37
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$502.98
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$402.39
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
