|
HC BETA 2 GLYCOPROTEIN I IGG M A
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$25.45
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGM M A
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$25.45
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGM M A
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC BETA 2 GP1 AB IGA
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC BETA 2 GP1 AB IGA
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$39.45 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$25.45
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.54
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$26.04
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGG
|
Facility
|
IP
|
$45.56
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200142
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$45.56 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: ASR ASR |
$44.19
|
| Rate for Payer: BCBS Trust/PPO |
$37.41
|
| Rate for Payer: BCN Commercial |
$37.41
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$44.19
|
| Rate for Payer: Healthscope Whirlpool |
$45.56
|
| Rate for Payer: Mclaren Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: Nomi Health Commercial |
$37.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.09
|
|
|
HC BETA 2 GP1 AB IGG
|
Facility
|
OP
|
$45.56
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200142
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$45.56 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$44.19
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.56
|
| Rate for Payer: BCN Commercial |
$37.56
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$44.19
|
| Rate for Payer: Healthscope Whirlpool |
$45.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$41.00
|
| Rate for Payer: Mclaren Medicaid |
$25.45
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: Nomi Health Commercial |
$37.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.17
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.92
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$31.94
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGM
|
Facility
|
OP
|
$52.43
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$47.19
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$50.86
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$43.23
|
| Rate for Payer: BCN Commercial |
$43.23
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$50.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$47.19
|
| Rate for Payer: Mclaren Medicaid |
$25.45
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$42.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.32
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.94
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$36.75
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGM
|
Facility
|
IP
|
$52.43
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$47.19
|
| Rate for Payer: ASR ASR |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$43.06
|
| Rate for Payer: BCN Commercial |
$43.06
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$50.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| Rate for Payer: Mclaren Commercial |
$47.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$42.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.14
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: Aetna Commercial |
$39.16
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.73
|
| Rate for Payer: BCN Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Healthscope Whirlpool |
$43.51
|
| Rate for Payer: Mclaren Commercial |
$39.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.29
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$55.69 |
| Rate for Payer: Aetna Commercial |
$39.16
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: BCBS MAPPO |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$35.87
|
| Rate for Payer: BCN Commercial |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.18
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Healthscope Whirlpool |
$43.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.18
|
| Rate for Payer: Mclaren Commercial |
$39.16
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Mclaren Medicare |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.99
|
| Rate for Payer: Meridian Medicaid |
$8.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PACE Medicare |
$15.37
|
| Rate for Payer: PACE SWMI |
$16.18
|
| Rate for Payer: PHP Commercial |
$17.80
|
| Rate for Payer: PHP Medicaid |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Medicare |
$16.18
|
| Rate for Payer: Priority Health Narrow Network |
$44.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.18
|
| Rate for Payer: UHC Exchange |
$25.08
|
| Rate for Payer: UHC Medicaid |
$8.46
|
| Rate for Payer: UHCCP DNSP |
$16.18
|
| Rate for Payer: UHCCP Medicaid |
$8.46
|
| Rate for Payer: VA VA |
$16.18
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
OP
|
$28.98
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna Commercial |
$26.08
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$28.11
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.89
|
| Rate for Payer: BCN Commercial |
$23.89
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$27.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$28.11
|
| Rate for Payer: Healthscope Whirlpool |
$28.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.17
|
| Rate for Payer: Mclaren Commercial |
$26.08
|
| Rate for Payer: Mclaren Medicaid |
$8.17
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$8.99
|
| Rate for Payer: PHP Medicaid |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.25
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$21.80
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.17
|
| Rate for Payer: UHC Exchange |
$12.66
|
| Rate for Payer: UHC Medicaid |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.27
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
IP
|
$28.98
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna Commercial |
$26.08
|
| Rate for Payer: ASR ASR |
$28.11
|
| Rate for Payer: BCBS Trust/PPO |
$23.80
|
| Rate for Payer: BCN Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$27.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$28.11
|
| Rate for Payer: Healthscope Whirlpool |
$28.98
|
| Rate for Payer: Mclaren Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.50
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$625.04
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$625.04 |
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$606.29
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$515.35
|
| Rate for Payer: BCN Commercial |
$515.35
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$500.03
|
| Rate for Payer: Cash Price |
$500.03
|
| Rate for Payer: Cofinity Commercial |
$587.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$606.29
|
| Rate for Payer: Healthscope Whirlpool |
$625.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$562.54
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$531.28
|
| Rate for Payer: Nomi Health Commercial |
$512.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.78
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$547.66
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$438.15
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$550.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$625.04
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.78 |
| Max. Negotiated Rate |
$625.04 |
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: ASR ASR |
$606.29
|
| Rate for Payer: BCBS Trust/PPO |
$513.28
|
| Rate for Payer: BCN Commercial |
$513.28
|
| Rate for Payer: Cash Price |
$500.03
|
| Rate for Payer: Cofinity Commercial |
$587.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.03
|
| Rate for Payer: Healthscope Commercial |
$606.29
|
| Rate for Payer: Healthscope Whirlpool |
$625.04
|
| Rate for Payer: Mclaren Commercial |
$562.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$531.28
|
| Rate for Payer: Nomi Health Commercial |
$512.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$550.04
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$753.25
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.94 |
| Max. Negotiated Rate |
$753.25 |
| Rate for Payer: Aetna Commercial |
$677.92
|
| Rate for Payer: ASR ASR |
$730.65
|
| Rate for Payer: BCBS Trust/PPO |
$618.57
|
| Rate for Payer: BCN Commercial |
$618.57
|
| Rate for Payer: Cash Price |
$602.60
|
| Rate for Payer: Cofinity Commercial |
$708.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.60
|
| Rate for Payer: Healthscope Commercial |
$730.65
|
| Rate for Payer: Healthscope Whirlpool |
$753.25
|
| Rate for Payer: Mclaren Commercial |
$677.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.26
|
| Rate for Payer: Nomi Health Commercial |
$617.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.86
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$753.25
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$753.25 |
| Rate for Payer: Aetna Commercial |
$677.92
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$730.65
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$621.05
|
| Rate for Payer: BCN Commercial |
$621.05
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$602.60
|
| Rate for Payer: Cash Price |
$602.60
|
| Rate for Payer: Cofinity Commercial |
$708.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$730.65
|
| Rate for Payer: Healthscope Whirlpool |
$753.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$677.92
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.26
|
| Rate for Payer: Nomi Health Commercial |
$617.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.94
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$660.00
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$528.03
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$128.15
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$128.15 |
| Rate for Payer: Aetna Commercial |
$115.33
|
| Rate for Payer: Aetna Medicare |
$47.42
|
| Rate for Payer: ASR ASR |
$124.31
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Trust/PPO |
$105.66
|
| Rate for Payer: BCN Commercial |
$105.66
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.52
|
| Rate for Payer: Healthscope Commercial |
$124.31
|
| Rate for Payer: Healthscope Whirlpool |
$128.15
|
| Rate for Payer: Mclaren Commercial |
$115.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| Rate for Payer: Nomi Health Commercial |
$105.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$89.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.77
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$128.15
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$128.15 |
| Rate for Payer: Aetna Commercial |
$115.33
|
| Rate for Payer: ASR ASR |
$124.31
|
| Rate for Payer: BCBS Trust/PPO |
$105.24
|
| Rate for Payer: BCN Commercial |
$105.24
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cofinity Commercial |
$120.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.52
|
| Rate for Payer: Healthscope Commercial |
$124.31
|
| Rate for Payer: Healthscope Whirlpool |
$128.15
|
| Rate for Payer: Mclaren Commercial |
$115.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| Rate for Payer: Nomi Health Commercial |
$105.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.77
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
IP
|
$466.10
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.57 |
| Max. Negotiated Rate |
$466.10 |
| Rate for Payer: Aetna Commercial |
$419.49
|
| Rate for Payer: ASR ASR |
$452.12
|
| Rate for Payer: BCBS Trust/PPO |
$382.76
|
| Rate for Payer: BCN Commercial |
$382.76
|
| Rate for Payer: Cash Price |
$372.88
|
| Rate for Payer: Cofinity Commercial |
$438.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.88
|
| Rate for Payer: Healthscope Commercial |
$452.12
|
| Rate for Payer: Healthscope Whirlpool |
$466.10
|
| Rate for Payer: Mclaren Commercial |
$419.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.17
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
OP
|
$466.10
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$466.10 |
| Rate for Payer: Aetna Commercial |
$419.49
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$452.12
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$384.30
|
| Rate for Payer: BCN Commercial |
$384.30
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$372.88
|
| Rate for Payer: Cash Price |
$372.88
|
| Rate for Payer: Cofinity Commercial |
$438.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$452.12
|
| Rate for Payer: Healthscope Whirlpool |
$466.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$419.49
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.57
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$186.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$149.13
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$14,773.12
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11,079.84 |
| Max. Negotiated Rate |
$14,773.12 |
| Rate for Payer: Aetna Commercial |
$13,295.81
|
| Rate for Payer: ASR ASR |
$14,329.93
|
| Rate for Payer: BCBS Trust/PPO |
$12,131.69
|
| Rate for Payer: BCN Commercial |
$12,131.69
|
| Rate for Payer: Cash Price |
$11,818.50
|
| Rate for Payer: Cofinity Commercial |
$13,886.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,818.50
|
| Rate for Payer: Healthscope Commercial |
$14,329.93
|
| Rate for Payer: Healthscope Whirlpool |
$14,773.12
|
| Rate for Payer: Mclaren Commercial |
$13,295.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,557.15
|
| Rate for Payer: Nomi Health Commercial |
$12,113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,079.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,000.35
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$14,773.12
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$14,773.12 |
| Rate for Payer: Aetna Commercial |
$13,295.81
|
| Rate for Payer: Aetna Medicare |
$6,350.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: ASR ASR |
$14,329.93
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$12,180.44
|
| Rate for Payer: BCN Commercial |
$12,180.44
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$11,818.50
|
| Rate for Payer: Cash Price |
$11,818.50
|
| Rate for Payer: Cofinity Commercial |
$13,886.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,818.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$14,329.93
|
| Rate for Payer: Healthscope Whirlpool |
$14,773.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,350.08
|
| Rate for Payer: Mclaren Commercial |
$13,295.81
|
| Rate for Payer: Mclaren Medicaid |
$6,350.08
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$3,487.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,557.15
|
| Rate for Payer: Nomi Health Commercial |
$12,113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,079.84
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$6,985.09
|
| Rate for Payer: PHP Medicaid |
$3,403.64
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,944.21
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health Narrow Network |
$10,355.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,000.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Exchange |
$9,842.62
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP DNSP |
$6,350.08
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$925.96
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$925.96 |
| Rate for Payer: Aetna Commercial |
$833.36
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$898.18
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$763.45
|
| Rate for Payer: BCN Commercial |
$763.45
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$740.77
|
| Rate for Payer: Cash Price |
$740.77
|
| Rate for Payer: Cofinity Commercial |
$870.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$898.18
|
| Rate for Payer: Healthscope Whirlpool |
$925.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$833.36
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.07
|
| Rate for Payer: Nomi Health Commercial |
$759.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.47
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$811.33
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$649.10
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$814.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$925.96
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$694.47 |
| Max. Negotiated Rate |
$925.96 |
| Rate for Payer: Aetna Commercial |
$833.36
|
| Rate for Payer: ASR ASR |
$898.18
|
| Rate for Payer: BCBS Trust/PPO |
$760.40
|
| Rate for Payer: BCN Commercial |
$760.40
|
| Rate for Payer: Cash Price |
$740.77
|
| Rate for Payer: Cofinity Commercial |
$870.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.77
|
| Rate for Payer: Healthscope Commercial |
$898.18
|
| Rate for Payer: Healthscope Whirlpool |
$925.96
|
| Rate for Payer: Mclaren Commercial |
$833.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.07
|
| Rate for Payer: Nomi Health Commercial |
$759.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$814.84
|
|
