|
HC TX INCOMPLETE AB ANY TRI SURG
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,506.59
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,961.87
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$5,569.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Trust/PPO |
$6,474.81
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,506.59
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,961.87
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$5,569.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
OP
|
$775.65
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$698.09
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$752.38
|
| Rate for Payer: ASR Commercial |
$752.38
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$635.18
|
| Rate for Payer: BCN Commercial |
$601.36
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$620.52
|
| Rate for Payer: Cash Price |
$620.52
|
| Rate for Payer: Cofinity Commercial |
$729.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$775.65
|
| Rate for Payer: Healthscope Whirlpool |
$752.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$698.09
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.30
|
| Rate for Payer: Nomi Health Commercial |
$636.03
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.62
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$543.73
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
IP
|
$775.65
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.17 |
| Max. Negotiated Rate |
$775.65 |
| Rate for Payer: Aetna Commercial |
$698.09
|
| Rate for Payer: ASR ASR |
$752.38
|
| Rate for Payer: ASR Commercial |
$752.38
|
| Rate for Payer: BCBS Trust/PPO |
$632.08
|
| Rate for Payer: BCN Commercial |
$601.36
|
| Rate for Payer: Cash Price |
$620.52
|
| Rate for Payer: Cofinity Commercial |
$729.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.52
|
| Rate for Payer: Healthscope Commercial |
$775.65
|
| Rate for Payer: Healthscope Whirlpool |
$752.38
|
| Rate for Payer: Mclaren Commercial |
$698.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.30
|
| Rate for Payer: Nomi Health Commercial |
$636.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.57
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$362.62 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: Aetna Medicare |
$233.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: ASR Commercial |
$325.97
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$275.19
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$325.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$257.35
|
| Rate for Payer: PHP Medicaid |
$125.40
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.45
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$235.57
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$362.62
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP DNSP |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: ASR Commercial |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$273.85
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$325.97
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,285.00 |
| Rate for Payer: Aetna Commercial |
$3,856.50
|
| Rate for Payer: Aetna Medicare |
$1,444.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: ASR ASR |
$4,156.45
|
| Rate for Payer: ASR Commercial |
$4,156.45
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,508.99
|
| Rate for Payer: BCN Commercial |
$3,322.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cofinity Commercial |
$4,027.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Healthscope Commercial |
$4,285.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,156.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,444.66
|
| Rate for Payer: Mclaren Commercial |
$3,856.50
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.25
|
| Rate for Payer: Nomi Health Commercial |
$3,513.70
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Commercial |
$1,589.13
|
| Rate for Payer: PHP Medicaid |
$774.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,754.52
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,003.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,770.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,239.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP DNSP |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
IP
|
$4,285.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,785.25 |
| Max. Negotiated Rate |
$4,285.00 |
| Rate for Payer: Aetna Commercial |
$3,856.50
|
| Rate for Payer: ASR ASR |
$4,156.45
|
| Rate for Payer: ASR Commercial |
$4,156.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,491.85
|
| Rate for Payer: BCN Commercial |
$3,322.16
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cofinity Commercial |
$4,027.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.00
|
| Rate for Payer: Healthscope Commercial |
$4,285.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,156.45
|
| Rate for Payer: Mclaren Commercial |
$3,856.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.25
|
| Rate for Payer: Nomi Health Commercial |
$3,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,770.80
|
|
|
HC TYMPANOMETRY
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.74
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
|
|
HC TYMPANOMETRY
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.85
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$134.03
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$144.45
|
| Rate for Payer: ASR Commercial |
$144.45
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$121.95
|
| Rate for Payer: BCN Commercial |
$115.46
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| 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 |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$148.92
|
| Rate for Payer: Healthscope Whirlpool |
$144.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$134.03
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| 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 |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$104.39
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| 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 TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.86
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: Aetna Medicare |
$496.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.23
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$496.66
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Commercial |
$546.33
|
| Rate for Payer: PHP Medicaid |
$266.21
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.14
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Priority Health Narrow Network |
$940.97
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP DNSP |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna Medicare |
$2.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.74
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.99
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: PACE Medicare |
$2.84
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: PHP Medicaid |
$1.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.99
|
| Rate for Payer: UHC Exchange |
$4.63
|
| Rate for Payer: UHC Medicare Advantage |
$2.99
|
| Rate for Payer: UHCCP DNSP |
$2.99
|
| Rate for Payer: UHCCP Medicaid |
$1.60
|
| Rate for Payer: VA VA |
$2.99
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Aetna Medicare |
$9.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: ASR ASR |
$36.71
|
| Rate for Payer: ASR Commercial |
$36.71
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$31.00
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$35.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$37.85
|
| Rate for Payer: Healthscope Whirlpool |
$36.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.77
|
| Rate for Payer: Mclaren Commercial |
$34.06
|
| Rate for Payer: Mclaren Medicaid |
$5.24
|
| Rate for Payer: Mclaren Medicare |
$9.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.26
|
| Rate for Payer: Meridian Medicaid |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: PACE Medicare |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.77
|
| Rate for Payer: PHP Commercial |
$10.75
|
| Rate for Payer: PHP Medicaid |
$5.24
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.16
|
| Rate for Payer: Priority Health Medicare |
$9.77
|
| Rate for Payer: Priority Health Narrow Network |
$26.53
|
| Rate for Payer: Railroad Medicare Medicare |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.77
|
| Rate for Payer: UHC Exchange |
$15.14
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: UHCCP DNSP |
$9.77
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: VA VA |
$9.77
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: ASR ASR |
$36.71
|
| Rate for Payer: ASR Commercial |
$36.71
|
| Rate for Payer: BCBS Trust/PPO |
$30.84
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$35.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Healthscope Commercial |
$37.85
|
| Rate for Payer: Healthscope Whirlpool |
$36.71
|
| Rate for Payer: Mclaren Commercial |
$34.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.31
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,823.25 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: ASR ASR |
$2,720.85
|
| Rate for Payer: ASR Commercial |
$2,720.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,285.79
|
| Rate for Payer: BCN Commercial |
$2,174.72
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,636.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,720.85
|
| Rate for Payer: Mclaren Commercial |
$2,524.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,468.40
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Medicare |
$1,402.50
|
| Rate for Payer: ASR ASR |
$2,720.85
|
| Rate for Payer: ASR Commercial |
$2,720.85
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,297.01
|
| Rate for Payer: BCN Commercial |
$2,174.72
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,636.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,720.85
|
| Rate for Payer: Mclaren Commercial |
$2,524.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,457.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,966.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,468.40
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.29
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.25
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$1.21
|
| Rate for Payer: Mclaren Medicare |
$2.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$1.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: PHP Medicaid |
$1.21
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.59
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP DNSP |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$1.21
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: ASR Commercial |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.17
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Healthscope Whirlpool |
$12.11
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: ASR Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Healthscope Whirlpool |
$12.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Meridian Medicaid |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: PHP Medicaid |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health Narrow Network |
$8.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Exchange |
$5.39
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
| Rate for Payer: UHCCP DNSP |
$3.48
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$3.48
|
|
