|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$520.46 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$194.36
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.46
|
| Rate for Payer: Priority Health Narrow Network |
$416.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
IP
|
$691.91
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.74 |
| Max. Negotiated Rate |
$691.91 |
| Rate for Payer: Aetna Commercial |
$622.72
|
| Rate for Payer: ASR ASR |
$671.15
|
| Rate for Payer: ASR Commercial |
$671.15
|
| Rate for Payer: BCBS Trust/PPO |
$563.84
|
| Rate for Payer: BCN Commercial |
$536.44
|
| Rate for Payer: Cash Price |
$553.53
|
| Rate for Payer: Cofinity Commercial |
$650.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.53
|
| Rate for Payer: Healthscope Commercial |
$691.91
|
| Rate for Payer: Healthscope Whirlpool |
$671.15
|
| Rate for Payer: Mclaren Commercial |
$622.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.12
|
| Rate for Payer: Nomi Health Commercial |
$567.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.88
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
OP
|
$691.91
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$691.91 |
| Rate for Payer: Aetna Commercial |
$622.72
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$671.15
|
| Rate for Payer: ASR Commercial |
$671.15
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$566.61
|
| Rate for Payer: BCN Commercial |
$536.44
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$553.53
|
| Rate for Payer: Cash Price |
$553.53
|
| Rate for Payer: Cofinity Commercial |
$650.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$691.91
|
| Rate for Payer: Healthscope Whirlpool |
$671.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$622.72
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.12
|
| Rate for Payer: Nomi Health Commercial |
$567.37
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.25
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$485.03
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC US OB FU
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$397.99
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.95
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$219.16
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB FU
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Trust/PPO |
$396.04
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
OP
|
$581.99
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$581.99 |
| Rate for Payer: Aetna Commercial |
$523.79
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$564.53
|
| Rate for Payer: ASR Commercial |
$564.53
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$476.59
|
| Rate for Payer: BCN Commercial |
$451.22
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$465.59
|
| Rate for Payer: Cash Price |
$465.59
|
| Rate for Payer: Cofinity Commercial |
$547.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$581.99
|
| Rate for Payer: Healthscope Whirlpool |
$564.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$523.79
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.69
|
| Rate for Payer: Nomi Health Commercial |
$477.23
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.30
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$374.64
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
IP
|
$581.99
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$581.99 |
| Rate for Payer: Aetna Commercial |
$523.79
|
| Rate for Payer: ASR ASR |
$564.53
|
| Rate for Payer: ASR Commercial |
$564.53
|
| Rate for Payer: BCBS Trust/PPO |
$474.26
|
| Rate for Payer: BCN Commercial |
$451.22
|
| Rate for Payer: Cash Price |
$465.59
|
| Rate for Payer: Cofinity Commercial |
$547.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.59
|
| Rate for Payer: Healthscope Commercial |
$581.99
|
| Rate for Payer: Healthscope Whirlpool |
$564.53
|
| Rate for Payer: Mclaren Commercial |
$523.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.69
|
| Rate for Payer: Nomi Health Commercial |
$477.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.15
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
IP
|
$581.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$378.21 |
| Max. Negotiated Rate |
$581.86 |
| Rate for Payer: Aetna Commercial |
$523.67
|
| Rate for Payer: ASR ASR |
$564.40
|
| Rate for Payer: ASR Commercial |
$564.40
|
| Rate for Payer: BCBS Trust/PPO |
$474.16
|
| Rate for Payer: BCN Commercial |
$451.12
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cofinity Commercial |
$546.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.49
|
| Rate for Payer: Healthscope Commercial |
$581.86
|
| Rate for Payer: Healthscope Whirlpool |
$564.40
|
| Rate for Payer: Mclaren Commercial |
$523.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.58
|
| Rate for Payer: Nomi Health Commercial |
$477.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.04
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
OP
|
$581.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$581.86 |
| Rate for Payer: Aetna Commercial |
$523.67
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$564.40
|
| Rate for Payer: ASR Commercial |
$564.40
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$476.49
|
| Rate for Payer: BCN Commercial |
$451.12
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cofinity Commercial |
$546.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$581.86
|
| Rate for Payer: Healthscope Whirlpool |
$564.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$523.67
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.58
|
| Rate for Payer: Nomi Health Commercial |
$477.13
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.35
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$312.28
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB LTD
|
Facility
|
OP
|
$486.11
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$486.11 |
| Rate for Payer: Aetna Commercial |
$437.50
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$471.53
|
| Rate for Payer: ASR Commercial |
$471.53
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$398.08
|
| Rate for Payer: BCN Commercial |
$376.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cofinity Commercial |
$456.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$486.11
|
| Rate for Payer: Healthscope Whirlpool |
$471.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$437.50
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.19
|
| Rate for Payer: Nomi Health Commercial |
$398.61
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.95
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$219.16
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB LTD
|
Facility
|
IP
|
$486.11
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.97 |
| Max. Negotiated Rate |
$486.11 |
| Rate for Payer: Aetna Commercial |
$437.50
|
| Rate for Payer: ASR ASR |
$471.53
|
| Rate for Payer: ASR Commercial |
$471.53
|
| Rate for Payer: BCBS Trust/PPO |
$396.13
|
| Rate for Payer: BCN Commercial |
$376.88
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cofinity Commercial |
$456.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.89
|
| Rate for Payer: Healthscope Commercial |
$486.11
|
| Rate for Payer: Healthscope Whirlpool |
$471.53
|
| Rate for Payer: Mclaren Commercial |
$437.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.19
|
| Rate for Payer: Nomi Health Commercial |
$398.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.78
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$176.49
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$367.83 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Aetna Medicare |
$88.24
|
| Rate for Payer: ASR ASR |
$171.20
|
| Rate for Payer: ASR Commercial |
$171.20
|
| Rate for Payer: BCBS Complete |
$70.60
|
| Rate for Payer: BCBS Trust/PPO |
$144.53
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.19
|
| Rate for Payer: Healthscope Commercial |
$176.49
|
| Rate for Payer: Healthscope Whirlpool |
$171.20
|
| Rate for Payer: Mclaren Commercial |
$158.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.02
|
| Rate for Payer: Nomi Health Commercial |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.83
|
| Rate for Payer: Priority Health Narrow Network |
$294.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.31
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$176.49
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$176.49 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: ASR ASR |
$171.20
|
| Rate for Payer: ASR Commercial |
$171.20
|
| Rate for Payer: BCBS Trust/PPO |
$143.82
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.19
|
| Rate for Payer: Healthscope Commercial |
$176.49
|
| Rate for Payer: Healthscope Whirlpool |
$171.20
|
| Rate for Payer: Mclaren Commercial |
$158.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.02
|
| Rate for Payer: Nomi Health Commercial |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.31
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$458.39
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$480.92 |
| Rate for Payer: Aetna Commercial |
$412.55
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$444.64
|
| Rate for Payer: ASR Commercial |
$444.64
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$375.38
|
| Rate for Payer: BCN Commercial |
$355.39
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cofinity Commercial |
$430.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$458.39
|
| Rate for Payer: Healthscope Whirlpool |
$444.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$412.55
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.63
|
| Rate for Payer: Nomi Health Commercial |
$375.88
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.92
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$384.74
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$458.39
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.95 |
| Max. Negotiated Rate |
$458.39 |
| Rate for Payer: Aetna Commercial |
$412.55
|
| Rate for Payer: ASR ASR |
$444.64
|
| Rate for Payer: ASR Commercial |
$444.64
|
| Rate for Payer: BCBS Trust/PPO |
$373.54
|
| Rate for Payer: BCN Commercial |
$355.39
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cofinity Commercial |
$430.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.71
|
| Rate for Payer: Healthscope Commercial |
$458.39
|
| Rate for Payer: Healthscope Whirlpool |
$444.64
|
| Rate for Payer: Mclaren Commercial |
$412.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.63
|
| Rate for Payer: Nomi Health Commercial |
$375.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.38
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$398.27 |
| Rate for Payer: Aetna Commercial |
$358.44
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$386.32
|
| Rate for Payer: ASR Commercial |
$386.32
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$326.14
|
| Rate for Payer: BCN Commercial |
$308.78
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$374.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$398.27
|
| Rate for Payer: Healthscope Whirlpool |
$386.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$358.44
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: Nomi Health Commercial |
$326.58
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.35
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$312.28
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.88 |
| Max. Negotiated Rate |
$398.27 |
| Rate for Payer: Aetna Commercial |
$358.44
|
| Rate for Payer: ASR ASR |
$386.32
|
| Rate for Payer: ASR Commercial |
$386.32
|
| Rate for Payer: BCBS Trust/PPO |
$324.55
|
| Rate for Payer: BCN Commercial |
$308.78
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$374.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Healthscope Commercial |
$398.27
|
| Rate for Payer: Healthscope Whirlpool |
$386.32
|
| Rate for Payer: Mclaren Commercial |
$358.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: Nomi Health Commercial |
$326.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.48
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Trust/PPO |
$887.43
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$891.78
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$954.18
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$763.39
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.37 |
| Max. Negotiated Rate |
$1,499.88 |
| Rate for Payer: Aetna Commercial |
$1,232.12
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$1,327.95
|
| Rate for Payer: ASR Commercial |
$1,327.95
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.09
|
| Rate for Payer: BCN Commercial |
$1,061.40
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$1,286.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$1,369.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,327.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$1,232.12
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: Nomi Health Commercial |
$1,122.60
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.88
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.90
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,204.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$889.86 |
| Max. Negotiated Rate |
$1,369.02 |
| Rate for Payer: Aetna Commercial |
$1,232.12
|
| Rate for Payer: ASR ASR |
$1,327.95
|
| Rate for Payer: ASR Commercial |
$1,327.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,115.61
|
| Rate for Payer: BCN Commercial |
$1,061.40
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$1,286.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Healthscope Commercial |
$1,369.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,327.95
|
| Rate for Payer: Mclaren Commercial |
$1,232.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: Nomi Health Commercial |
$1,122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,204.74
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$417.96
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.11
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$260.89
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| Rate for Payer: ASR ASR |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Trust/PPO |
$415.92
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$918.71 |
| Rate for Payer: Aetna Commercial |
$826.84
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$891.15
|
| Rate for Payer: ASR Commercial |
$891.15
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$752.33
|
| Rate for Payer: BCN Commercial |
$712.28
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$863.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$918.71
|
| Rate for Payer: Healthscope Whirlpool |
$891.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$826.84
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.22
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$364.98
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$597.16 |
| Max. Negotiated Rate |
$918.71 |
| Rate for Payer: Aetna Commercial |
$826.84
|
| Rate for Payer: ASR ASR |
$891.15
|
| Rate for Payer: ASR Commercial |
$891.15
|
| Rate for Payer: BCBS Trust/PPO |
$748.66
|
| Rate for Payer: BCN Commercial |
$712.28
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$863.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Healthscope Commercial |
$918.71
|
| Rate for Payer: Healthscope Whirlpool |
$891.15
|
| Rate for Payer: Mclaren Commercial |
$826.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.46
|
|
