|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.54 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Medicare |
$89.54
|
| Rate for Payer: ASR ASR |
$234.74
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.53
|
| Rate for Payer: BCN Commercial |
$199.53
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$234.74
|
| Rate for Payer: Healthscope Whirlpool |
$242.00
|
| Rate for Payer: Mclaren Commercial |
$217.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$212.04
|
| Rate for Payer: Priority Health Narrow Network |
$169.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.96
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: ASR ASR |
$234.74
|
| Rate for Payer: BCBS Trust/PPO |
$198.73
|
| Rate for Payer: BCN Commercial |
$198.73
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$234.74
|
| Rate for Payer: Healthscope Whirlpool |
$242.00
|
| Rate for Payer: Mclaren Commercial |
$217.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.96
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Medicare |
$128.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: ASR ASR |
$468.51
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$398.23
|
| Rate for Payer: BCN Commercial |
$398.23
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$454.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$468.51
|
| Rate for Payer: Healthscope Whirlpool |
$483.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$434.70
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$70.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$396.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$141.03
|
| Rate for Payer: PHP Medicaid |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.60
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$137.28
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP DNSP |
$128.21
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: ASR ASR |
$468.51
|
| Rate for Payer: BCBS Trust/PPO |
$396.64
|
| Rate for Payer: BCN Commercial |
$396.64
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$454.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Healthscope Commercial |
$468.51
|
| Rate for Payer: Healthscope Whirlpool |
$483.00
|
| Rate for Payer: Mclaren Commercial |
$434.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$396.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.04
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$597.19 |
| Rate for Payer: Aetna Commercial |
$537.47
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: ASR ASR |
$579.27
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$492.38
|
| Rate for Payer: BCN Commercial |
$492.38
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Commercial |
$561.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$579.27
|
| Rate for Payer: Healthscope Whirlpool |
$597.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$537.47
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$119.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Nomi Health Commercial |
$489.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: PHP Medicaid |
$116.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$523.26
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health Narrow Network |
$418.63
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$525.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$338.19
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP DNSP |
$218.19
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$447.89 |
| Max. Negotiated Rate |
$597.19 |
| Rate for Payer: Aetna Commercial |
$537.47
|
| Rate for Payer: ASR ASR |
$579.27
|
| Rate for Payer: BCBS Trust/PPO |
$490.41
|
| Rate for Payer: BCN Commercial |
$490.41
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Commercial |
$561.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Healthscope Commercial |
$579.27
|
| Rate for Payer: Healthscope Whirlpool |
$597.19
|
| Rate for Payer: Mclaren Commercial |
$537.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Nomi Health Commercial |
$489.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$525.53
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Trust/PPO |
$83.47
|
| Rate for Payer: BCN Commercial |
$83.47
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$37.61 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Medicare |
$37.61
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Complete |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$83.80
|
| Rate for Payer: BCN Commercial |
$83.80
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.06
|
| Rate for Payer: Priority Health Narrow Network |
$71.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Trust/PPO |
$83.47
|
| Rate for Payer: BCN Commercial |
$83.47
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$37.61 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Medicare |
$37.61
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Complete |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$83.80
|
| Rate for Payer: BCN Commercial |
$83.80
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.06
|
| Rate for Payer: Priority Health Narrow Network |
$71.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
|
|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$30.29
|
| Rate for Payer: ASR ASR |
$32.65
|
| Rate for Payer: BCBS Trust/PPO |
$27.64
|
| Rate for Payer: BCN Commercial |
$27.64
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$31.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$32.65
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Mclaren Commercial |
$30.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.62
|
|
|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$30.29
|
| Rate for Payer: Aetna Medicare |
$12.45
|
| Rate for Payer: ASR ASR |
$32.65
|
| Rate for Payer: BCBS Complete |
$13.46
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCN Commercial |
$27.75
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$31.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$32.65
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Mclaren Commercial |
$30.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.49
|
| Rate for Payer: Priority Health Narrow Network |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.62
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.79 |
| Max. Negotiated Rate |
$681.01 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: Aetna Medicare |
$439.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.20
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Complete |
$241.30
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCBS Trust/PPO |
$449.74
|
| Rate for Payer: BCN Commercial |
$449.74
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$439.36
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Mclaren Medicaid |
$439.36
|
| Rate for Payer: Mclaren Medicare |
$439.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.33
|
| Rate for Payer: Meridian Medicaid |
$241.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$483.30
|
| Rate for Payer: PHP Medicaid |
$235.50
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.94
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health Narrow Network |
$382.37
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.36
|
| Rate for Payer: UHC Exchange |
$681.01
|
| Rate for Payer: UHC Medicaid |
$229.79
|
| Rate for Payer: UHCCP DNSP |
$439.36
|
| Rate for Payer: UHCCP Medicaid |
$229.79
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$409.10 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Trust/PPO |
$447.94
|
| Rate for Payer: BCN Commercial |
$447.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.79 |
| Max. Negotiated Rate |
$681.01 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: Aetna Medicare |
$439.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.20
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Complete |
$241.30
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCBS Trust/PPO |
$449.74
|
| Rate for Payer: BCN Commercial |
$449.74
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$439.36
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Mclaren Medicaid |
$439.36
|
| Rate for Payer: Mclaren Medicare |
$439.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.33
|
| Rate for Payer: Meridian Medicaid |
$241.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$483.30
|
| Rate for Payer: PHP Medicaid |
$235.50
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.94
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health Narrow Network |
$382.37
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.36
|
| Rate for Payer: UHC Exchange |
$681.01
|
| Rate for Payer: UHC Medicaid |
$229.79
|
| Rate for Payer: UHCCP DNSP |
$439.36
|
| Rate for Payer: UHCCP Medicaid |
$229.79
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$409.10 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Trust/PPO |
$447.94
|
| Rate for Payer: BCN Commercial |
$447.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.61
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Complete |
$22.24
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.80
|
| Rate for Payer: BCN Commercial |
$83.80
|
| Rate for Payer: BCN Medicare Advantage |
$40.49
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.49
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$40.49
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: Mclaren Medicaid |
$40.49
|
| Rate for Payer: Mclaren Medicare |
$40.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.51
|
| Rate for Payer: Meridian Medicaid |
$22.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PACE Medicare |
$38.47
|
| Rate for Payer: PACE SWMI |
$40.49
|
| Rate for Payer: PHP Commercial |
$44.54
|
| Rate for Payer: PHP Medicaid |
$21.70
|
| Rate for Payer: PHP Medicare Advantage |
$40.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.06
|
| Rate for Payer: Priority Health Medicare |
$40.49
|
| Rate for Payer: Priority Health Narrow Network |
$71.25
|
| Rate for Payer: Railroad Medicare Medicare |
$40.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.49
|
| Rate for Payer: UHC Exchange |
$62.76
|
| Rate for Payer: UHC Medicaid |
$21.18
|
| Rate for Payer: UHCCP DNSP |
$40.49
|
| Rate for Payer: UHCCP Medicaid |
$21.18
|
| Rate for Payer: VA VA |
$40.49
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: ASR ASR |
$98.59
|
| Rate for Payer: BCBS Trust/PPO |
$83.47
|
| Rate for Payer: BCN Commercial |
$83.47
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$95.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$98.59
|
| Rate for Payer: Healthscope Whirlpool |
$101.64
|
| Rate for Payer: Mclaren Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.44
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$233.04 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$38.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: ASR ASR |
$67.08
|
| Rate for Payer: BCBS Complete |
$21.21
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.01
|
| Rate for Payer: BCN Commercial |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$67.08
|
| Rate for Payer: Healthscope Whirlpool |
$69.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.62
|
| Rate for Payer: Mclaren Commercial |
$62.23
|
| Rate for Payer: Mclaren Medicaid |
$38.62
|
| Rate for Payer: Mclaren Medicare |
$38.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: Meridian Medicaid |
$21.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicaid |
$20.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.04
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health Narrow Network |
$186.43
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.62
|
| Rate for Payer: UHC Exchange |
$59.86
|
| Rate for Payer: UHC Medicaid |
$20.20
|
| Rate for Payer: UHCCP DNSP |
$38.62
|
| Rate for Payer: UHCCP Medicaid |
$20.20
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.86 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: ASR ASR |
$67.08
|
| Rate for Payer: BCBS Trust/PPO |
$56.79
|
| Rate for Payer: BCN Commercial |
$56.79
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$67.08
|
| Rate for Payer: Healthscope Whirlpool |
$69.15
|
| Rate for Payer: Mclaren Commercial |
$62.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.85
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.82
|
| Rate for Payer: BCN Commercial |
$12.82
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Whirlpool |
$15.61
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Whirlpool |
$15.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$2.17
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$30.56
|
| Rate for Payer: ASR ASR |
$32.94
|
| Rate for Payer: BCBS Trust/PPO |
$27.89
|
| Rate for Payer: BCN Commercial |
$27.89
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Whirlpool |
$33.96
|
| Rate for Payer: Mclaren Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.88
|
|
