|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$54.67
|
| Rate for Payer: BCN Commercial |
$54.67
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$76.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.28
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health Tiered Network |
$41.02
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.92
|
| Rate for Payer: UHC Core |
$76.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.28
|
| Rate for Payer: UHC Exchange |
$76.92
|
| Rate for Payer: UHC Medicaid |
$26.82
|
| Rate for Payer: UHCCP Medicaid |
$26.82
|
| Rate for Payer: VA VA |
$51.28
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: BCBS Complete |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$113.05
|
| Rate for Payer: BCN Commercial |
$113.05
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.30
|
| Rate for Payer: UHC Core |
$64.30
|
| Rate for Payer: UHC Exchange |
$64.30
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.50
|
| Rate for Payer: BCBS Complete |
$8.13
|
| Rate for Payer: BCBS MAPPO |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCN Commercial |
$15.78
|
| Rate for Payer: BCN Medicare Advantage |
$14.80
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$7.74
|
| Rate for Payer: Mclaren Medicare |
$14.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.54
|
| Rate for Payer: Meridian Medicaid |
$15.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$22.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PACE Medicare |
$14.06
|
| Rate for Payer: PACE SWMI |
$14.80
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$14.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.80
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Priority Health Tiered Network |
$11.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.20
|
| Rate for Payer: UHC Core |
$22.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.80
|
| Rate for Payer: UHC Exchange |
$22.20
|
| Rate for Payer: UHC Medicaid |
$7.74
|
| Rate for Payer: UHCCP Medicaid |
$7.74
|
| Rate for Payer: VA VA |
$14.80
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$108.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.62
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Advantage |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$109.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: PHP Commercial |
$108.04
|
| Rate for Payer: Priority Health SBD |
$80.08
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.84 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$108.04
|
| Rate for Payer: Aetna Medicare |
$63.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.62
|
| Rate for Payer: BCBS Complete |
$50.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.04
|
| Rate for Payer: BCN Commercial |
$120.04
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Advantage |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$109.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: PHP Commercial |
$108.04
|
| Rate for Payer: Priority Health SBD |
$80.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.49
|
| Rate for Payer: UHC Core |
$65.49
|
| Rate for Payer: UHC Exchange |
$65.49
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health SBD |
$59.25
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.08
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$7.40
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: Meridian Medicaid |
$14.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.14
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health Tiered Network |
$11.31
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.21
|
| Rate for Payer: UHC Core |
$21.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.14
|
| Rate for Payer: UHC Exchange |
$21.21
|
| Rate for Payer: UHC Medicaid |
$7.40
|
| Rate for Payer: UHCCP Medicaid |
$7.40
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$32.59
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.00
|
| Rate for Payer: Priority Health SBD |
$63.52
|
| Rate for Payer: Priority Health Tiered Network |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.53
|
| Rate for Payer: UHC Core |
$52.53
|
| Rate for Payer: UHC Exchange |
$39.62
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health SBD |
$63.52
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,642.16 |
| Max. Negotiated Rate |
$2,345.94 |
| Rate for Payer: Aetna Commercial |
$2,215.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.29
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Advantage |
$1,824.62
|
| Rate for Payer: Cofinity Commercial |
$2,241.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Healthscope Commercial |
$2,345.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: PHP Commercial |
$2,215.61
|
| Rate for Payer: Priority Health SBD |
$1,642.16
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.61 |
| Max. Negotiated Rate |
$5,018.47 |
| Rate for Payer: Aetna Commercial |
$2,215.61
|
| Rate for Payer: Aetna Medicare |
$1,613.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,437.61
|
| Rate for Payer: BCN Commercial |
$1,437.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Advantage |
$1,824.62
|
| Rate for Payer: Cofinity Commercial |
$2,241.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,345.94
|
| Rate for Payer: Mclaren Medicaid |
$811.61
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$1,629.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$4,655.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$2,215.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,018.47
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health SBD |
$1,642.16
|
| Rate for Payer: Priority Health Tiered Network |
$4,014.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.29
|
| Rate for Payer: UHC Core |
$1,358.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$1,024.39
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,594.32 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.94
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Advantage |
$1,771.47
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: Priority Health SBD |
$1,594.32
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.61 |
| Max. Negotiated Rate |
$5,018.47 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna Medicare |
$1,613.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$837.21
|
| Rate for Payer: BCN Commercial |
$837.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Advantage |
$1,771.47
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Mclaren Medicaid |
$811.61
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$1,629.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$4,655.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,018.47
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health SBD |
$1,594.32
|
| Rate for Payer: Priority Health Tiered Network |
$4,014.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,644.94
|
| Rate for Payer: UHC Core |
$1,318.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$994.55
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,594.32 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.94
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Advantage |
$1,771.47
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: Priority Health SBD |
$1,594.32
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.77 |
| Max. Negotiated Rate |
$5,018.47 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna Medicare |
$1,613.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$679.77
|
| Rate for Payer: BCN Commercial |
$679.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Advantage |
$1,771.47
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Mclaren Medicaid |
$811.61
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$1,629.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$4,655.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,018.47
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health SBD |
$1,594.32
|
| Rate for Payer: Priority Health Tiered Network |
$4,014.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,644.94
|
| Rate for Payer: UHC Core |
$1,318.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$994.55
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.87
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Advantage |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: Priority Health SBD |
$73.54
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$58.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.87
|
| Rate for Payer: BCBS Complete |
$46.69
|
| Rate for Payer: BCBS Trust/PPO |
$27.11
|
| Rate for Payer: BCN Commercial |
$27.11
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Advantage |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.00
|
| Rate for Payer: Priority Health SBD |
$73.54
|
| Rate for Payer: Priority Health Tiered Network |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.87
|
| Rate for Payer: UHC Core |
$60.82
|
| Rate for Payer: UHC Exchange |
$45.87
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.72 |
| Max. Negotiated Rate |
$792.45 |
| Rate for Payer: Aetna Commercial |
$748.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.33
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Advantage |
$616.35
|
| Rate for Payer: Cofinity Commercial |
$757.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Healthscope Commercial |
$792.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| Rate for Payer: PHP Commercial |
$748.42
|
| Rate for Payer: Priority Health SBD |
$554.72
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$792.45 |
| Rate for Payer: Aetna Commercial |
$748.42
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$392.33
|
| Rate for Payer: BCN Commercial |
$392.33
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Advantage |
$616.35
|
| Rate for Payer: Cofinity Commercial |
$757.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$792.45
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.42
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$748.42
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$554.72
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.33
|
| Rate for Payer: UHC Core |
$458.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$346.04
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
OP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$529.32 |
| Rate for Payer: Aetna Commercial |
$499.91
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$85.47
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Advantage |
$411.69
|
| Rate for Payer: Cofinity Commercial |
$505.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$529.32
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$499.91
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$370.52
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
IP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$370.52 |
| Max. Negotiated Rate |
$529.32 |
| Rate for Payer: Aetna Commercial |
$499.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.28
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Advantage |
$411.69
|
| Rate for Payer: Cofinity Commercial |
$505.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Healthscope Commercial |
$529.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: PHP Commercial |
$499.91
|
| Rate for Payer: Priority Health SBD |
$370.52
|
|
