|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$177.97
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$177.97 |
| Rate for Payer: Aetna Commercial |
$160.17
|
| Rate for Payer: ASR ASR |
$172.63
|
| Rate for Payer: BCBS Trust/PPO |
$137.98
|
| Rate for Payer: BCN Commercial |
$137.98
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$167.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.38
|
| Rate for Payer: Healthscope Commercial |
$177.97
|
| Rate for Payer: Healthscope Whirlpool |
$172.63
|
| Rate for Payer: Mclaren Commercial |
$160.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.61
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$177.97
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$177.97 |
| Rate for Payer: Aetna Commercial |
$160.17
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$172.63
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$137.98
|
| Rate for Payer: BCN Commercial |
$137.98
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$167.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$177.97
|
| Rate for Payer: Healthscope Whirlpool |
$172.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$160.17
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.27
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.95
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$126.36
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.61
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$355.93
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$249.15 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$320.34
|
| Rate for Payer: ASR ASR |
$345.25
|
| Rate for Payer: BCBS Trust/PPO |
$275.95
|
| Rate for Payer: BCN Commercial |
$275.95
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$334.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.74
|
| Rate for Payer: Healthscope Commercial |
$355.93
|
| Rate for Payer: Healthscope Whirlpool |
$345.25
|
| Rate for Payer: Mclaren Commercial |
$320.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.22
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$355.93
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$320.34
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$345.25
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$275.95
|
| Rate for Payer: BCN Commercial |
$275.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$334.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$355.93
|
| Rate for Payer: Healthscope Whirlpool |
$345.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$320.34
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.90
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$252.71
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.22
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$355.93
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$249.15 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$320.34
|
| Rate for Payer: ASR ASR |
$345.25
|
| Rate for Payer: BCBS Trust/PPO |
$275.95
|
| Rate for Payer: BCN Commercial |
$275.95
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$334.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.74
|
| Rate for Payer: Healthscope Commercial |
$355.93
|
| Rate for Payer: Healthscope Whirlpool |
$345.25
|
| Rate for Payer: Mclaren Commercial |
$320.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.22
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$355.93
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$320.34
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$345.25
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$275.95
|
| Rate for Payer: BCN Commercial |
$275.95
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$334.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$355.93
|
| Rate for Payer: Healthscope Whirlpool |
$345.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$320.34
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.90
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$252.71
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.22
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$508.47
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$508.47 |
| Rate for Payer: Aetna Commercial |
$457.62
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$493.22
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$394.22
|
| Rate for Payer: BCN Commercial |
$394.22
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cofinity Commercial |
$477.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$508.47
|
| Rate for Payer: Healthscope Whirlpool |
$493.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$457.62
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.20
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.42
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.45
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$508.47
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$355.93 |
| Max. Negotiated Rate |
$508.47 |
| Rate for Payer: Aetna Commercial |
$457.62
|
| Rate for Payer: ASR ASR |
$493.22
|
| Rate for Payer: BCBS Trust/PPO |
$394.22
|
| Rate for Payer: BCN Commercial |
$394.22
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cofinity Commercial |
$477.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.78
|
| Rate for Payer: Healthscope Commercial |
$508.47
|
| Rate for Payer: Healthscope Whirlpool |
$493.22
|
| Rate for Payer: Mclaren Commercial |
$457.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.45
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$311.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$311.34 |
| Rate for Payer: Aetna Commercial |
$280.21
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$302.00
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$241.38
|
| Rate for Payer: BCN Commercial |
$241.38
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$292.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$311.34
|
| Rate for Payer: Healthscope Whirlpool |
$302.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$280.21
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.27
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$132.22
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.98
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
IP
|
$311.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.94 |
| Max. Negotiated Rate |
$311.34 |
| Rate for Payer: Aetna Commercial |
$280.21
|
| Rate for Payer: ASR ASR |
$302.00
|
| Rate for Payer: BCBS Trust/PPO |
$241.38
|
| Rate for Payer: BCN Commercial |
$241.38
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$292.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.07
|
| Rate for Payer: Healthscope Commercial |
$311.34
|
| Rate for Payer: Healthscope Whirlpool |
$302.00
|
| Rate for Payer: Mclaren Commercial |
$280.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.98
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: ASR ASR |
$7.73
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$6.18
|
| Rate for Payer: BCN Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Healthscope Whirlpool |
$7.73
|
| Rate for Payer: Mclaren Commercial |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.25
|
| Rate for Payer: Priority Health Narrow Network |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.01
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: ASR ASR |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.18
|
| Rate for Payer: BCN Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Healthscope Whirlpool |
$7.73
|
| Rate for Payer: Mclaren Commercial |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.01
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$30.37
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna Commercial |
$27.33
|
| Rate for Payer: ASR ASR |
$29.46
|
| Rate for Payer: BCBS Complete |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.30
|
| Rate for Payer: Healthscope Commercial |
$30.37
|
| Rate for Payer: Healthscope Whirlpool |
$29.46
|
| Rate for Payer: Mclaren Commercial |
$27.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.64
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.73
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.37
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna Commercial |
$27.33
|
| Rate for Payer: ASR ASR |
$29.46
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.30
|
| Rate for Payer: Healthscope Commercial |
$30.37
|
| Rate for Payer: Healthscope Whirlpool |
$29.46
|
| Rate for Payer: Mclaren Commercial |
$27.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.73
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC BACK SCREEN
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.19
|
| Rate for Payer: Priority Health Narrow Network |
$48.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$78.02
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$106.50
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
OP
|
$8.70
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: ASR ASR |
$8.44
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$8.70
|
| Rate for Payer: Healthscope Whirlpool |
$8.44
|
| Rate for Payer: Mclaren Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health Narrow Network |
$6.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.66
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$8.70
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: ASR ASR |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$8.70
|
| Rate for Payer: Healthscope Whirlpool |
$8.44
|
| Rate for Payer: Mclaren Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.66
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: ASR ASR |
$61.11
|
| Rate for Payer: BCBS Trust/PPO |
$48.84
|
| Rate for Payer: BCN Commercial |
$48.84
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Whirlpool |
$61.11
|
| Rate for Payer: Mclaren Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.44
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: ASR ASR |
$61.11
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$48.84
|
| Rate for Payer: BCN Commercial |
$48.84
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Whirlpool |
$61.11
|
| Rate for Payer: Mclaren Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.33
|
| Rate for Payer: Priority Health Narrow Network |
$44.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.44
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$733.86
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$513.70 |
| Max. Negotiated Rate |
$733.86 |
| Rate for Payer: Aetna Commercial |
$660.47
|
| Rate for Payer: ASR ASR |
$711.84
|
| Rate for Payer: BCBS Trust/PPO |
$568.96
|
| Rate for Payer: BCN Commercial |
$568.96
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cofinity Commercial |
$689.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.09
|
| Rate for Payer: Healthscope Commercial |
$733.86
|
| Rate for Payer: Healthscope Whirlpool |
$711.84
|
| Rate for Payer: Mclaren Commercial |
$660.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$645.80
|
|
