|
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
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$754.91 |
| Max. Negotiated Rate |
$1,887.28 |
| Rate for Payer: Aetna Commercial |
$1,698.55
|
| Rate for Payer: ASR ASR |
$1,830.66
|
| Rate for Payer: BCBS Complete |
$754.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.21
|
| Rate for Payer: BCN Commercial |
$1,463.21
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,774.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Healthscope Commercial |
$1,887.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,830.66
|
| Rate for Payer: Mclaren Commercial |
$1,698.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,717.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,339.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,660.81
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,321.10 |
| Max. Negotiated Rate |
$1,887.28 |
| Rate for Payer: Aetna Commercial |
$1,698.55
|
| Rate for Payer: ASR ASR |
$1,830.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.21
|
| Rate for Payer: BCN Commercial |
$1,463.21
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,774.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Healthscope Commercial |
$1,887.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,830.66
|
| Rate for Payer: Mclaren Commercial |
$1,698.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,660.81
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$80.85 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: ASR ASR |
$78.42
|
| Rate for Payer: BCBS Complete |
$32.34
|
| Rate for Payer: BCBS Trust/PPO |
$62.68
|
| Rate for Payer: BCN Commercial |
$62.68
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$76.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$80.85
|
| Rate for Payer: Healthscope Whirlpool |
$78.42
|
| Rate for Payer: Mclaren Commercial |
$72.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.57
|
| Rate for Payer: Priority Health Narrow Network |
$57.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.15
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$80.85 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: ASR ASR |
$78.42
|
| Rate for Payer: BCBS Trust/PPO |
$62.68
|
| Rate for Payer: BCN Commercial |
$62.68
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$76.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$80.85
|
| Rate for Payer: Healthscope Whirlpool |
$78.42
|
| Rate for Payer: Mclaren Commercial |
$72.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.15
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.93 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: BCBS Trust/PPO |
$189.32
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$189.32
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.21
|
| Rate for Payer: Priority Health Narrow Network |
$173.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$412.78 |
| Rate for Payer: Aetna Commercial |
$371.50
|
| Rate for Payer: ASR ASR |
$400.40
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.03
|
| Rate for Payer: BCN Commercial |
$320.03
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$388.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$412.78
|
| Rate for Payer: Healthscope Whirlpool |
$400.40
|
| Rate for Payer: Mclaren Commercial |
$371.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.63
|
| Rate for Payer: Priority Health Narrow Network |
$293.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.25
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.95 |
| Max. Negotiated Rate |
$412.78 |
| Rate for Payer: Aetna Commercial |
$371.50
|
| Rate for Payer: ASR ASR |
$400.40
|
| Rate for Payer: BCBS Trust/PPO |
$320.03
|
| Rate for Payer: BCN Commercial |
$320.03
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$388.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$412.78
|
| Rate for Payer: Healthscope Whirlpool |
$400.40
|
| Rate for Payer: Mclaren Commercial |
$371.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.25
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.61 |
| Max. Negotiated Rate |
$576.58 |
| Rate for Payer: Aetna Commercial |
$518.92
|
| Rate for Payer: ASR ASR |
$559.28
|
| Rate for Payer: BCBS Trust/PPO |
$447.02
|
| Rate for Payer: BCN Commercial |
$447.02
|
| Rate for Payer: Cash Price |
$461.26
|
| Rate for Payer: Cofinity Commercial |
$541.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.26
|
| Rate for Payer: Healthscope Commercial |
$576.58
|
| Rate for Payer: Healthscope Whirlpool |
$559.28
|
| Rate for Payer: Mclaren Commercial |
$518.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.39
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$576.58 |
| Rate for Payer: Aetna Commercial |
$518.92
|
| Rate for Payer: ASR ASR |
$559.28
|
| Rate for Payer: BCBS Complete |
$230.63
|
| Rate for Payer: BCBS Trust/PPO |
$447.02
|
| Rate for Payer: BCN Commercial |
$447.02
|
| Rate for Payer: Cash Price |
$461.26
|
| Rate for Payer: Cofinity Commercial |
$541.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.26
|
| Rate for Payer: Healthscope Commercial |
$576.58
|
| Rate for Payer: Healthscope Whirlpool |
$559.28
|
| Rate for Payer: Mclaren Commercial |
$518.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.69
|
| Rate for Payer: Priority Health Narrow Network |
$409.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.39
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.60 |
| Max. Negotiated Rate |
$678.00 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: ASR ASR |
$657.66
|
| Rate for Payer: BCBS Trust/PPO |
$525.65
|
| Rate for Payer: BCN Commercial |
$525.65
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$637.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Healthscope Commercial |
$678.00
|
| Rate for Payer: Healthscope Whirlpool |
$657.66
|
| Rate for Payer: Mclaren Commercial |
$610.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$678.00 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: ASR ASR |
$657.66
|
| Rate for Payer: BCBS Complete |
$271.20
|
| Rate for Payer: BCBS Trust/PPO |
$525.65
|
| Rate for Payer: BCN Commercial |
$525.65
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$637.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Healthscope Commercial |
$678.00
|
| Rate for Payer: Healthscope Whirlpool |
$657.66
|
| Rate for Payer: Mclaren Commercial |
$610.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$616.98
|
| Rate for Payer: Priority Health Narrow Network |
$481.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$782.46
|
| Rate for Payer: ASR ASR |
$843.32
|
| Rate for Payer: BCBS Trust/PPO |
$674.05
|
| Rate for Payer: BCN Commercial |
$674.05
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$817.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$869.40
|
| Rate for Payer: Healthscope Whirlpool |
$843.32
|
| Rate for Payer: Mclaren Commercial |
$782.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.07
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$782.46
|
| Rate for Payer: ASR ASR |
$843.32
|
| Rate for Payer: BCBS Complete |
$347.76
|
| Rate for Payer: BCBS Trust/PPO |
$674.05
|
| Rate for Payer: BCN Commercial |
$674.05
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$817.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$869.40
|
| Rate for Payer: Healthscope Whirlpool |
$843.32
|
| Rate for Payer: Mclaren Commercial |
$782.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.15
|
| Rate for Payer: Priority Health Narrow Network |
$617.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.07
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,250.68 |
| Max. Negotiated Rate |
$3,126.70 |
| Rate for Payer: Aetna Commercial |
$2,814.03
|
| Rate for Payer: ASR ASR |
$3,032.90
|
| Rate for Payer: BCBS Complete |
$1,250.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,424.13
|
| Rate for Payer: BCN Commercial |
$2,424.13
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,939.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Healthscope Commercial |
$3,126.70
|
| Rate for Payer: Healthscope Whirlpool |
$3,032.90
|
| Rate for Payer: Mclaren Commercial |
$2,814.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,845.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,219.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,751.50
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,188.69 |
| Max. Negotiated Rate |
$3,126.70 |
| Rate for Payer: Aetna Commercial |
$2,814.03
|
| Rate for Payer: ASR ASR |
$3,032.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,424.13
|
| Rate for Payer: BCN Commercial |
$2,424.13
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,939.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Healthscope Commercial |
$3,126.70
|
| Rate for Payer: Healthscope Whirlpool |
$3,032.90
|
| Rate for Payer: Mclaren Commercial |
$2,814.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,751.50
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: ASR ASR |
$13.02
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.40
|
| Rate for Payer: BCN Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Healthscope Whirlpool |
$13.02
|
| Rate for Payer: Mclaren Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.21
|
| Rate for Payer: Priority Health Narrow Network |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.81
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: ASR ASR |
$13.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.40
|
| Rate for Payer: BCN Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Healthscope Whirlpool |
$13.02
|
| Rate for Payer: Mclaren Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.81
|
|
|
HC BANDING
|
Facility
|
OP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$378.68 |
| Max. Negotiated Rate |
$946.71 |
| Rate for Payer: Aetna Commercial |
$852.04
|
| Rate for Payer: ASR ASR |
$918.31
|
| Rate for Payer: BCBS Complete |
$378.68
|
| Rate for Payer: BCBS Trust/PPO |
$733.98
|
| Rate for Payer: BCN Commercial |
$733.98
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$889.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Healthscope Commercial |
$946.71
|
| Rate for Payer: Healthscope Whirlpool |
$918.31
|
| Rate for Payer: Mclaren Commercial |
$852.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$861.51
|
| Rate for Payer: Priority Health Narrow Network |
$672.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$833.10
|
|
|
HC BANDING
|
Facility
|
IP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$662.70 |
| Max. Negotiated Rate |
$946.71 |
| Rate for Payer: Aetna Commercial |
$852.04
|
| Rate for Payer: ASR ASR |
$918.31
|
| Rate for Payer: BCBS Trust/PPO |
$733.98
|
| Rate for Payer: BCN Commercial |
$733.98
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$889.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Healthscope Commercial |
$946.71
|
| Rate for Payer: Healthscope Whirlpool |
$918.31
|
| Rate for Payer: Mclaren Commercial |
$852.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$833.10
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
