|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| 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 |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| 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 |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| 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 |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
| 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 UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$726.66 |
| Rate for Payer: Aetna Commercial |
$653.99
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$704.86
|
| Rate for Payer: ASR Commercial |
$704.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$563.38
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$683.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$726.66
|
| Rate for Payer: Healthscope Whirlpool |
$704.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$653.99
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.70
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$509.39
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$726.66 |
| Rate for Payer: Aetna Commercial |
$653.99
|
| Rate for Payer: ASR ASR |
$704.86
|
| Rate for Payer: ASR Commercial |
$704.86
|
| Rate for Payer: BCBS Trust/PPO |
$592.16
|
| Rate for Payer: BCN Commercial |
$563.38
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$683.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Healthscope Commercial |
$726.66
|
| Rate for Payer: Healthscope Whirlpool |
$704.86
|
| Rate for Payer: Mclaren Commercial |
$653.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.46
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: Aetna Medicare |
$226.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: ASR Commercial |
$643.11
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCBS Trust/PPO |
$542.93
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$226.48
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Commercial |
$249.13
|
| Rate for Payer: PHP Medicaid |
$121.39
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.92
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Priority Health Narrow Network |
$464.76
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$351.04
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP DNSP |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.95 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: ASR Commercial |
$643.11
|
| Rate for Payer: BCBS Trust/PPO |
$540.28
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,887.84 |
| Max. Negotiated Rate |
$2,904.37 |
| Rate for Payer: Aetna Commercial |
$2,613.93
|
| Rate for Payer: ASR ASR |
$2,817.24
|
| Rate for Payer: ASR Commercial |
$2,817.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,366.77
|
| Rate for Payer: BCN Commercial |
$2,251.76
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,730.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Healthscope Commercial |
$2,904.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,817.24
|
| Rate for Payer: Mclaren Commercial |
$2,613.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,887.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,555.85
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$2,904.37 |
| Rate for Payer: Aetna Commercial |
$2,613.93
|
| 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 |
$2,817.24
|
| Rate for Payer: ASR Commercial |
$2,817.24
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.39
|
| Rate for Payer: BCN Commercial |
$2,251.76
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,730.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$2,904.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,817.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$2,613.93
|
| 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 |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| 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 |
$1,887.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,544.81
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,035.96
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,555.85
|
| 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 UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$456.97 |
| Rate for Payer: Aetna Commercial |
$411.27
|
| 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 |
$443.26
|
| Rate for Payer: ASR Commercial |
$443.26
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$374.21
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$429.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$456.97
|
| Rate for Payer: Healthscope Whirlpool |
$443.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$411.27
|
| 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 |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| 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 |
$297.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$320.34
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.13
|
| 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 UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.03 |
| Max. Negotiated Rate |
$456.97 |
| Rate for Payer: Aetna Commercial |
$411.27
|
| Rate for Payer: ASR ASR |
$443.26
|
| Rate for Payer: ASR Commercial |
$443.26
|
| Rate for Payer: BCBS Trust/PPO |
$372.38
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$429.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Healthscope Commercial |
$456.97
|
| Rate for Payer: Healthscope Whirlpool |
$443.26
|
| Rate for Payer: Mclaren Commercial |
$411.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.13
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$330.53
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$356.24
|
| Rate for Payer: ASR Commercial |
$356.24
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$300.75
|
| Rate for Payer: BCN Commercial |
$284.74
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$345.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Healthscope Whirlpool |
$356.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$330.53
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.79
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$257.45
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.72 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$330.53
|
| Rate for Payer: ASR ASR |
$356.24
|
| Rate for Payer: ASR Commercial |
$356.24
|
| Rate for Payer: BCBS Trust/PPO |
$299.28
|
| Rate for Payer: BCN Commercial |
$284.74
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$345.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Healthscope Whirlpool |
$356.24
|
| Rate for Payer: Mclaren Commercial |
$330.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.19
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,864.38 |
| Max. Negotiated Rate |
$9,022.12 |
| Rate for Payer: Aetna Commercial |
$8,119.91
|
| Rate for Payer: ASR ASR |
$8,751.46
|
| Rate for Payer: ASR Commercial |
$8,751.46
|
| Rate for Payer: BCBS Trust/PPO |
$7,352.13
|
| Rate for Payer: BCN Commercial |
$6,994.85
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$8,480.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Healthscope Commercial |
$9,022.12
|
| Rate for Payer: Healthscope Whirlpool |
$8,751.46
|
| Rate for Payer: Mclaren Commercial |
$8,119.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,939.47
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,470.75 |
| Max. Negotiated Rate |
$15,820.28 |
| Rate for Payer: Aetna Commercial |
$8,119.91
|
| Rate for Payer: Aetna Medicare |
$10,206.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,758.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,758.29
|
| Rate for Payer: ASR ASR |
$8,751.46
|
| Rate for Payer: ASR Commercial |
$8,751.46
|
| Rate for Payer: BCBS Complete |
$5,744.29
|
| Rate for Payer: BCBS MAPPO |
$10,206.63
|
| Rate for Payer: BCBS Trust/PPO |
$7,388.21
|
| Rate for Payer: BCN Commercial |
$6,994.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,206.63
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$8,480.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,206.63
|
| Rate for Payer: Healthscope Commercial |
$9,022.12
|
| Rate for Payer: Healthscope Whirlpool |
$8,751.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,206.63
|
| Rate for Payer: Mclaren Commercial |
$8,119.91
|
| Rate for Payer: Mclaren Medicaid |
$5,470.75
|
| Rate for Payer: Mclaren Medicare |
$10,206.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,716.96
|
| Rate for Payer: Meridian Medicaid |
$5,744.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,737.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: PACE Medicare |
$9,696.30
|
| Rate for Payer: PACE SWMI |
$10,206.63
|
| Rate for Payer: PHP Commercial |
$11,227.29
|
| Rate for Payer: PHP Medicaid |
$5,470.75
|
| Rate for Payer: PHP Medicare Advantage |
$10,206.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,470.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,905.18
|
| Rate for Payer: Priority Health Medicare |
$10,206.63
|
| Rate for Payer: Priority Health Narrow Network |
$6,324.51
|
| Rate for Payer: Railroad Medicare Medicare |
$10,206.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,939.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,206.63
|
| Rate for Payer: UHC Exchange |
$15,820.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,206.63
|
| Rate for Payer: UHCCP DNSP |
$10,206.63
|
| Rate for Payer: UHCCP Medicaid |
$5,470.75
|
| Rate for Payer: VA VA |
$10,206.63
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,647.80
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,021.07 |
| Max. Negotiated Rate |
$15,820.28 |
| Rate for Payer: Aetna Commercial |
$4,183.02
|
| Rate for Payer: Aetna Medicare |
$10,206.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,758.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,758.29
|
| Rate for Payer: ASR ASR |
$4,508.37
|
| Rate for Payer: ASR Commercial |
$4,508.37
|
| Rate for Payer: BCBS Complete |
$5,744.29
|
| Rate for Payer: BCBS MAPPO |
$10,206.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,806.08
|
| Rate for Payer: BCN Commercial |
$3,603.44
|
| Rate for Payer: BCN Medicare Advantage |
$10,206.63
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cofinity Commercial |
$4,368.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,718.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,206.63
|
| Rate for Payer: Healthscope Commercial |
$4,647.80
|
| Rate for Payer: Healthscope Whirlpool |
$4,508.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,206.63
|
| Rate for Payer: Mclaren Commercial |
$4,183.02
|
| Rate for Payer: Mclaren Medicaid |
$5,470.75
|
| Rate for Payer: Mclaren Medicare |
$10,206.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,716.96
|
| Rate for Payer: Meridian Medicaid |
$5,744.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,737.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,950.63
|
| Rate for Payer: Nomi Health Commercial |
$3,811.20
|
| Rate for Payer: PACE Medicare |
$9,696.30
|
| Rate for Payer: PACE SWMI |
$10,206.63
|
| Rate for Payer: PHP Commercial |
$11,227.29
|
| Rate for Payer: PHP Medicaid |
$5,470.75
|
| Rate for Payer: PHP Medicare Advantage |
$10,206.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,470.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,021.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,072.40
|
| Rate for Payer: Priority Health Medicare |
$10,206.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,258.11
|
| Rate for Payer: Railroad Medicare Medicare |
$10,206.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,090.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,206.63
|
| Rate for Payer: UHC Exchange |
$15,820.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,206.63
|
| Rate for Payer: UHCCP DNSP |
$10,206.63
|
| Rate for Payer: UHCCP Medicaid |
$5,470.75
|
| Rate for Payer: VA VA |
$10,206.63
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,647.80
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,021.07 |
| Max. Negotiated Rate |
$4,647.80 |
| Rate for Payer: Aetna Commercial |
$4,183.02
|
| Rate for Payer: ASR ASR |
$4,508.37
|
| Rate for Payer: ASR Commercial |
$4,508.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,787.49
|
| Rate for Payer: BCN Commercial |
$3,603.44
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cofinity Commercial |
$4,368.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,718.24
|
| Rate for Payer: Healthscope Commercial |
$4,647.80
|
| Rate for Payer: Healthscope Whirlpool |
$4,508.37
|
| Rate for Payer: Mclaren Commercial |
$4,183.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,950.63
|
| Rate for Payer: Nomi Health Commercial |
$3,811.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,021.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,090.06
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.95
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicaid |
$2.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP DNSP |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.12
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: ASR Commercial |
$38.25
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$32.29
|
| Rate for Payer: BCN Commercial |
$30.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Healthscope Whirlpool |
$38.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.56
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$2.98
|
| Rate for Payer: Mclaren Medicare |
$5.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: PACE Medicare |
$5.28
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: PHP Medicaid |
$2.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.55
|
| Rate for Payer: Priority Health Medicare |
$5.56
|
| Rate for Payer: Priority Health Narrow Network |
$27.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Exchange |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: UHCCP DNSP |
$5.56
|
| Rate for Payer: UHCCP Medicaid |
$2.98
|
| Rate for Payer: VA VA |
$5.56
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: ASR Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$32.13
|
| Rate for Payer: BCN Commercial |
$30.57
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$39.43
|
| Rate for Payer: Healthscope Whirlpool |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
|
|
HC UREAPLASMA PCR
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: ASR Commercial |
$83.38
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$70.39
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Nomi Health Commercial |
$70.49
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.32
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$60.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.87 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: ASR Commercial |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$70.05
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Nomi Health Commercial |
$70.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
OP
|
$59.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$59.95 |
| Rate for Payer: Aetna Commercial |
$53.95
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$58.15
|
| Rate for Payer: ASR Commercial |
$58.15
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$49.09
|
| Rate for Payer: BCN Commercial |
$46.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$59.95
|
| Rate for Payer: Healthscope Whirlpool |
$58.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$53.95
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.96
|
| Rate for Payer: Nomi Health Commercial |
$49.16
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.53
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.02
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
IP
|
$59.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$59.95 |
| Rate for Payer: Aetna Commercial |
$53.95
|
| Rate for Payer: ASR ASR |
$58.15
|
| Rate for Payer: ASR Commercial |
$58.15
|
| Rate for Payer: BCBS Trust/PPO |
$48.85
|
| Rate for Payer: BCN Commercial |
$46.48
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.96
|
| Rate for Payer: Healthscope Commercial |
$59.95
|
| Rate for Payer: Healthscope Whirlpool |
$58.15
|
| Rate for Payer: Mclaren Commercial |
$53.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.96
|
| Rate for Payer: Nomi Health Commercial |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.76
|
|
