|
HC XR UGI GASTRO THIN BARM
|
Facility
|
IP
|
$315.25
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.44 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: ASR ASR |
$305.79
|
| Rate for Payer: BCBS Trust/PPO |
$258.88
|
| Rate for Payer: BCN Commercial |
$258.88
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cofinity Commercial |
$296.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.20
|
| Rate for Payer: Healthscope Commercial |
$305.79
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Mclaren Commercial |
$283.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.96
|
| Rate for Payer: Nomi Health Commercial |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.42
|
|
|
HC XR UPPER GI
|
Facility
|
OP
|
$595.21
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$595.21 |
| Rate for Payer: Aetna Commercial |
$535.69
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$577.35
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$490.75
|
| Rate for Payer: BCN Commercial |
$490.75
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cofinity Commercial |
$559.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$577.35
|
| Rate for Payer: Healthscope Whirlpool |
$595.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$535.69
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$488.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.41
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$521.52
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$417.24
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR UPPER GI
|
Facility
|
IP
|
$595.21
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.41 |
| Max. Negotiated Rate |
$595.21 |
| Rate for Payer: Aetna Commercial |
$535.69
|
| Rate for Payer: ASR ASR |
$577.35
|
| Rate for Payer: BCBS Trust/PPO |
$488.79
|
| Rate for Payer: BCN Commercial |
$488.79
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cofinity Commercial |
$559.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.17
|
| Rate for Payer: Healthscope Commercial |
$577.35
|
| Rate for Payer: Healthscope Whirlpool |
$595.21
|
| Rate for Payer: Mclaren Commercial |
$535.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$488.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.78
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
IP
|
$576.94
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$432.70 |
| Max. Negotiated Rate |
$576.94 |
| Rate for Payer: Aetna Commercial |
$519.25
|
| Rate for Payer: ASR ASR |
$559.63
|
| Rate for Payer: BCBS Trust/PPO |
$473.78
|
| Rate for Payer: BCN Commercial |
$473.78
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.55
|
| Rate for Payer: Healthscope Commercial |
$559.63
|
| Rate for Payer: Healthscope Whirlpool |
$576.94
|
| Rate for Payer: Mclaren Commercial |
$519.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.40
|
| Rate for Payer: Nomi Health Commercial |
$473.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.71
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
OP
|
$576.94
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$576.94 |
| Rate for Payer: Aetna Commercial |
$519.25
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$559.63
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$475.69
|
| Rate for Payer: BCN Commercial |
$475.69
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$559.63
|
| Rate for Payer: Healthscope Whirlpool |
$576.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$519.25
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.40
|
| Rate for Payer: Nomi Health Commercial |
$473.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.70
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$505.51
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$404.43
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
IP
|
$808.74
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$606.55 |
| Max. Negotiated Rate |
$808.74 |
| Rate for Payer: Aetna Commercial |
$727.87
|
| Rate for Payer: ASR ASR |
$784.48
|
| Rate for Payer: BCBS Trust/PPO |
$664.14
|
| Rate for Payer: BCN Commercial |
$664.14
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cofinity Commercial |
$760.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.99
|
| Rate for Payer: Healthscope Commercial |
$784.48
|
| Rate for Payer: Healthscope Whirlpool |
$808.74
|
| Rate for Payer: Mclaren Commercial |
$727.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.43
|
| Rate for Payer: Nomi Health Commercial |
$663.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$711.69
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
OP
|
$808.74
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$808.74 |
| Rate for Payer: Aetna Commercial |
$727.87
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$784.48
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$666.81
|
| Rate for Payer: BCN Commercial |
$666.81
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cofinity Commercial |
$760.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$784.48
|
| Rate for Payer: Healthscope Whirlpool |
$808.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$727.87
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.43
|
| Rate for Payer: Nomi Health Commercial |
$663.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.55
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$708.62
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$566.93
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$711.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR WRIST 2 VW
|
Facility
|
IP
|
$260.57
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.43 |
| Max. Negotiated Rate |
$260.57 |
| Rate for Payer: Aetna Commercial |
$234.51
|
| Rate for Payer: ASR ASR |
$252.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.98
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cofinity Commercial |
$244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.46
|
| Rate for Payer: Healthscope Commercial |
$252.75
|
| Rate for Payer: Healthscope Whirlpool |
$260.57
|
| Rate for Payer: Mclaren Commercial |
$234.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.48
|
| Rate for Payer: Nomi Health Commercial |
$213.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.30
|
|
|
HC XR WRIST 2 VW
|
Facility
|
OP
|
$260.57
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$272.38 |
| Rate for Payer: Aetna Commercial |
$234.51
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$252.75
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$214.84
|
| Rate for Payer: BCN Commercial |
$214.84
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cofinity Commercial |
$244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$252.75
|
| Rate for Payer: Healthscope Whirlpool |
$260.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$234.51
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.48
|
| Rate for Payer: Nomi Health Commercial |
$213.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.43
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$245.44
|
| Rate for Payer: BCN Commercial |
$245.44
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Trust/PPO |
$244.45
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
|
|
HC XR WRIST BIL MIN 3 VW
|
Facility
|
IP
|
$460.68
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$460.68 |
| Rate for Payer: Aetna Commercial |
$414.61
|
| Rate for Payer: ASR ASR |
$446.86
|
| Rate for Payer: BCBS Trust/PPO |
$378.31
|
| Rate for Payer: BCN Commercial |
$378.31
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cofinity Commercial |
$433.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.54
|
| Rate for Payer: Healthscope Commercial |
$446.86
|
| Rate for Payer: Healthscope Whirlpool |
$460.68
|
| Rate for Payer: Mclaren Commercial |
$414.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.58
|
| Rate for Payer: Nomi Health Commercial |
$377.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.40
|
|
|
HC XR WRIST BIL MIN 3 VW
|
Facility
|
OP
|
$460.68
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$460.68 |
| Rate for Payer: Aetna Commercial |
$414.61
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$446.86
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$379.83
|
| Rate for Payer: BCN Commercial |
$379.83
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cofinity Commercial |
$433.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$446.86
|
| Rate for Payer: Healthscope Whirlpool |
$460.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$414.61
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.58
|
| Rate for Payer: Nomi Health Commercial |
$377.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.51
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.17
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$235.33
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST MIN 3 VW
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$343.29
|
| Rate for Payer: BCN Commercial |
$343.29
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.17
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$235.33
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST MIN 3 VW
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.27 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
|
|
HC XTRASORB 6X9 EACH
|
Facility
|
IP
|
$16.59
|
|
| Hospital Charge Code |
27200293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: ASR ASR |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.62
|
| Rate for Payer: BCN Commercial |
$13.62
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Whirlpool |
$16.59
|
| Rate for Payer: Mclaren Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$13.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.60
|
|
|
HC XTRASORB 6X9 EACH
|
Facility
|
OP
|
$16.59
|
|
| Hospital Charge Code |
27200293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Medicare |
$6.14
|
| Rate for Payer: ASR ASR |
$16.09
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.68
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Whirlpool |
$16.59
|
| Rate for Payer: Mclaren Commercial |
$14.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$13.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.54
|
| Rate for Payer: Priority Health Narrow Network |
$11.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.60
|
|
|
HC Y ADAPTER WITH VENT
|
Facility
|
OP
|
$54.65
|
|
| Hospital Charge Code |
27006702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Aetna Commercial |
$49.19
|
| Rate for Payer: Aetna Medicare |
$20.22
|
| Rate for Payer: ASR ASR |
$53.01
|
| Rate for Payer: BCBS Complete |
$21.86
|
| Rate for Payer: BCBS Trust/PPO |
$45.06
|
| Rate for Payer: BCN Commercial |
$45.06
|
| Rate for Payer: Cash Price |
$43.72
|
| Rate for Payer: Cofinity Commercial |
$51.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.72
|
| Rate for Payer: Healthscope Commercial |
$53.01
|
| Rate for Payer: Healthscope Whirlpool |
$54.65
|
| Rate for Payer: Mclaren Commercial |
$49.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.45
|
| Rate for Payer: Nomi Health Commercial |
$44.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.88
|
| Rate for Payer: Priority Health Narrow Network |
$38.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.09
|
|
|
HC Y ADAPTER WITH VENT
|
Facility
|
IP
|
$54.65
|
|
| Hospital Charge Code |
27006702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Aetna Commercial |
$49.19
|
| Rate for Payer: ASR ASR |
$53.01
|
| Rate for Payer: BCBS Trust/PPO |
$44.88
|
| Rate for Payer: BCN Commercial |
$44.88
|
| Rate for Payer: Cash Price |
$43.72
|
| Rate for Payer: Cofinity Commercial |
$51.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.72
|
| Rate for Payer: Healthscope Commercial |
$53.01
|
| Rate for Payer: Healthscope Whirlpool |
$54.65
|
| Rate for Payer: Mclaren Commercial |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.45
|
| Rate for Payer: Nomi Health Commercial |
$44.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.09
|
|
|
HC YEAST BREWERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200111
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC YEAST BREWERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200111
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC YELLOW DOCK IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC YELLOW DOCK IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC YELLOW HORNET IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC YELLOW HORNET IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
