|
HC BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$4,101.81
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,875.37 |
| Max. Negotiated Rate |
$12,046.01 |
| Rate for Payer: Aetna Commercial |
$3,691.63
|
| Rate for Payer: Aetna Medicare |
$7,771.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,714.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,714.52
|
| Rate for Payer: ASR ASR |
$3,978.76
|
| Rate for Payer: BCBS Complete |
$4,268.17
|
| Rate for Payer: BCBS MAPPO |
$7,771.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,381.94
|
| Rate for Payer: BCN Commercial |
$3,381.94
|
| Rate for Payer: BCN Medicare Advantage |
$7,771.62
|
| Rate for Payer: Cash Price |
$3,281.45
|
| Rate for Payer: Cash Price |
$3,281.45
|
| Rate for Payer: Cofinity Commercial |
$3,855.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,281.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,771.62
|
| Rate for Payer: Healthscope Commercial |
$3,978.76
|
| Rate for Payer: Healthscope Whirlpool |
$4,101.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,771.62
|
| Rate for Payer: Mclaren Commercial |
$3,691.63
|
| Rate for Payer: Mclaren Medicaid |
$7,771.62
|
| Rate for Payer: Mclaren Medicare |
$7,771.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,160.20
|
| Rate for Payer: Meridian Medicaid |
$4,268.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,937.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,548.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,486.54
|
| Rate for Payer: Nomi Health Commercial |
$3,363.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,076.36
|
| Rate for Payer: PACE Medicare |
$7,383.04
|
| Rate for Payer: PACE SWMI |
$7,771.62
|
| Rate for Payer: PHP Commercial |
$8,548.78
|
| Rate for Payer: PHP Medicaid |
$4,165.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,771.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,064.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,594.01
|
| Rate for Payer: Priority Health Medicare |
$7,771.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,875.37
|
| Rate for Payer: Railroad Medicare Medicare |
$7,771.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,609.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,771.62
|
| Rate for Payer: UHC Exchange |
$12,046.01
|
| Rate for Payer: UHC Medicaid |
$4,064.56
|
| Rate for Payer: UHCCP DNSP |
$7,771.62
|
| Rate for Payer: UHCCP Medicaid |
$4,064.56
|
| Rate for Payer: VA VA |
$7,771.62
|
|
|
HC BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$4,101.81
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,076.36 |
| Max. Negotiated Rate |
$4,101.81 |
| Rate for Payer: Aetna Commercial |
$3,691.63
|
| Rate for Payer: ASR ASR |
$3,978.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,368.41
|
| Rate for Payer: BCN Commercial |
$3,368.41
|
| Rate for Payer: Cash Price |
$3,281.45
|
| Rate for Payer: Cofinity Commercial |
$3,855.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,281.45
|
| Rate for Payer: Healthscope Commercial |
$3,978.76
|
| Rate for Payer: Healthscope Whirlpool |
$4,101.81
|
| Rate for Payer: Mclaren Commercial |
$3,691.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,486.54
|
| Rate for Payer: Nomi Health Commercial |
$3,363.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,076.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,609.59
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: ASR ASR |
$1.49
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Healthscope Whirlpool |
$1.54
|
| Rate for Payer: Mclaren Commercial |
$1.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.31
|
| Rate for Payer: Nomi Health Commercial |
$1.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.36
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: ASR ASR |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$1.26
|
| Rate for Payer: BCN Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Healthscope Whirlpool |
$1.54
|
| Rate for Payer: Mclaren Commercial |
$1.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.31
|
| Rate for Payer: Nomi Health Commercial |
$1.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.36
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
OP
|
$181.03
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$181.03 |
| Rate for Payer: Aetna Commercial |
$162.93
|
| Rate for Payer: Aetna Medicare |
$66.98
|
| Rate for Payer: ASR ASR |
$175.60
|
| Rate for Payer: BCBS Complete |
$72.41
|
| Rate for Payer: BCBS Trust/PPO |
$149.26
|
| Rate for Payer: BCN Commercial |
$149.26
|
| Rate for Payer: Cash Price |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.82
|
| Rate for Payer: Healthscope Commercial |
$175.60
|
| Rate for Payer: Healthscope Whirlpool |
$181.03
|
| Rate for Payer: Mclaren Commercial |
$162.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.88
|
| Rate for Payer: Nomi Health Commercial |
$148.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$158.62
|
| Rate for Payer: Priority Health Narrow Network |
$126.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.31
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
IP
|
$181.03
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.77 |
| Max. Negotiated Rate |
$181.03 |
| Rate for Payer: Aetna Commercial |
$162.93
|
| Rate for Payer: ASR ASR |
$175.60
|
| Rate for Payer: BCBS Trust/PPO |
$148.66
|
| Rate for Payer: BCN Commercial |
$148.66
|
| Rate for Payer: Cash Price |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.82
|
| Rate for Payer: Healthscope Commercial |
$175.60
|
| Rate for Payer: Healthscope Whirlpool |
$181.03
|
| Rate for Payer: Mclaren Commercial |
$162.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.88
|
| Rate for Payer: Nomi Health Commercial |
$148.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.31
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC BURN CARE LARGE
|
Facility
|
IP
|
$705.48
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$529.11 |
| Max. Negotiated Rate |
$705.48 |
| Rate for Payer: Aetna Commercial |
$634.93
|
| Rate for Payer: ASR ASR |
$684.32
|
| Rate for Payer: BCBS Trust/PPO |
$579.34
|
| Rate for Payer: BCN Commercial |
$579.34
|
| Rate for Payer: Cash Price |
$564.38
|
| Rate for Payer: Cofinity Commercial |
$663.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.38
|
| Rate for Payer: Healthscope Commercial |
$684.32
|
| Rate for Payer: Healthscope Whirlpool |
$705.48
|
| Rate for Payer: Mclaren Commercial |
$634.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.66
|
| Rate for Payer: Nomi Health Commercial |
$578.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.82
|
|
|
HC BURN CARE LARGE
|
Facility
|
OP
|
$705.48
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$705.48 |
| Rate for Payer: Aetna Commercial |
$634.93
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$684.32
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$581.67
|
| Rate for Payer: BCN Commercial |
$581.67
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$564.38
|
| Rate for Payer: Cash Price |
$564.38
|
| Rate for Payer: Cofinity Commercial |
$663.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$684.32
|
| Rate for Payer: Healthscope Whirlpool |
$705.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$634.93
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.66
|
| Rate for Payer: Nomi Health Commercial |
$578.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.11
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.38
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$199.50
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
OP
|
$542.58
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$542.58 |
| Rate for Payer: Aetna Commercial |
$488.32
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$526.30
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$447.36
|
| Rate for Payer: BCN Commercial |
$447.36
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cofinity Commercial |
$510.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$526.30
|
| Rate for Payer: Healthscope Whirlpool |
$542.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$488.32
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.19
|
| Rate for Payer: Nomi Health Commercial |
$444.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.94
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.38
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$199.50
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$542.58
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.94 |
| Max. Negotiated Rate |
$542.58 |
| Rate for Payer: Aetna Commercial |
$488.32
|
| Rate for Payer: ASR ASR |
$526.30
|
| Rate for Payer: BCBS Trust/PPO |
$445.57
|
| Rate for Payer: BCN Commercial |
$445.57
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cofinity Commercial |
$510.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.06
|
| Rate for Payer: Healthscope Commercial |
$526.30
|
| Rate for Payer: Healthscope Whirlpool |
$542.58
|
| Rate for Payer: Mclaren Commercial |
$488.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.19
|
| Rate for Payer: Nomi Health Commercial |
$444.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.47
|
|
|
HC BURN CARE SMALL
|
Facility
|
OP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$372.50 |
| Rate for Payer: Aetna Commercial |
$335.25
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$361.32
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$307.13
|
| Rate for Payer: BCN Commercial |
$307.13
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Commercial |
$350.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$361.32
|
| Rate for Payer: Healthscope Whirlpool |
$372.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$335.25
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Nomi Health Commercial |
$305.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.38
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$199.50
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.38 |
| Max. Negotiated Rate |
$372.50 |
| Rate for Payer: Aetna Commercial |
$335.25
|
| Rate for Payer: ASR ASR |
$361.32
|
| Rate for Payer: BCBS Trust/PPO |
$305.90
|
| Rate for Payer: BCN Commercial |
$305.90
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Commercial |
$350.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Healthscope Commercial |
$361.32
|
| Rate for Payer: Healthscope Whirlpool |
$372.50
|
| Rate for Payer: Mclaren Commercial |
$335.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Nomi Health Commercial |
$305.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.80
|
|
|
HC BURN R&B
|
Facility
|
IP
|
$7,587.64
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$5,690.73 |
| Max. Negotiated Rate |
$7,587.64 |
| Rate for Payer: Aetna Commercial |
$6,828.88
|
| Rate for Payer: ASR ASR |
$7,360.01
|
| Rate for Payer: BCBS Trust/PPO |
$6,230.97
|
| Rate for Payer: BCN Commercial |
$6,230.97
|
| Rate for Payer: Cash Price |
$6,070.11
|
| Rate for Payer: Cofinity Commercial |
$7,132.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,070.11
|
| Rate for Payer: Healthscope Commercial |
$7,360.01
|
| Rate for Payer: Healthscope Whirlpool |
$7,587.64
|
| Rate for Payer: Mclaren Commercial |
$6,828.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,449.49
|
| Rate for Payer: Nomi Health Commercial |
$6,221.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,690.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,677.12
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.26 |
| Max. Negotiated Rate |
$228.35 |
| Rate for Payer: Aetna Commercial |
$205.51
|
| Rate for Payer: ASR ASR |
$221.50
|
| Rate for Payer: BCBS Trust/PPO |
$187.52
|
| Rate for Payer: BCN Commercial |
$187.52
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Commercial |
$214.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Healthscope Commercial |
$221.50
|
| Rate for Payer: Healthscope Whirlpool |
$228.35
|
| Rate for Payer: Mclaren Commercial |
$205.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Nomi Health Commercial |
$187.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.95
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$228.35 |
| Rate for Payer: Aetna Commercial |
$205.51
|
| Rate for Payer: Aetna Medicare |
$84.49
|
| Rate for Payer: ASR ASR |
$221.50
|
| Rate for Payer: BCBS Complete |
$91.34
|
| Rate for Payer: BCBS Trust/PPO |
$188.27
|
| Rate for Payer: BCN Commercial |
$188.27
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Commercial |
$214.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Healthscope Commercial |
$221.50
|
| Rate for Payer: Healthscope Whirlpool |
$228.35
|
| Rate for Payer: Mclaren Commercial |
$205.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Nomi Health Commercial |
$187.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.08
|
| Rate for Payer: Priority Health Narrow Network |
$160.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.95
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.87
|
| Rate for Payer: BCN Commercial |
$63.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$12.00
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.62
|
| Rate for Payer: BCN Commercial |
$63.62
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$345.01 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$73.72
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$62.66
|
| Rate for Payer: BCN Commercial |
$62.66
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$71.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Healthscope Whirlpool |
$76.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$68.40
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Nomi Health Commercial |
$62.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$276.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: ASR ASR |
$73.72
|
| Rate for Payer: BCBS Trust/PPO |
$62.41
|
| Rate for Payer: BCN Commercial |
$62.41
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$71.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Healthscope Whirlpool |
$76.00
|
| Rate for Payer: Mclaren Commercial |
$68.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Nomi Health Commercial |
$62.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.88
|
|
|
HC C1Q BINDING
|
Facility
|
IP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$103.93
|
| Rate for Payer: ASR ASR |
$112.02
|
| Rate for Payer: BCBS Trust/PPO |
$94.83
|
| Rate for Payer: BCN Commercial |
$94.83
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.48
|
| Rate for Payer: Mclaren Commercial |
$103.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.62
|
|
|
HC C1Q BINDING
|
Facility
|
OP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$103.93
|
| Rate for Payer: Aetna Medicare |
$24.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.46
|
| Rate for Payer: ASR ASR |
$112.02
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$95.21
|
| Rate for Payer: BCN Commercial |
$95.21
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.37
|
| Rate for Payer: Mclaren Commercial |
$103.93
|
| Rate for Payer: Mclaren Medicaid |
$24.37
|
| Rate for Payer: Mclaren Medicare |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.59
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PACE Medicare |
$23.15
|
| Rate for Payer: PACE SWMI |
$24.37
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: PHP Medicaid |
$13.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.18
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health Narrow Network |
$80.95
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.37
|
| Rate for Payer: UHC Exchange |
$37.77
|
| Rate for Payer: UHC Medicaid |
$12.75
|
| Rate for Payer: UHCCP DNSP |
$24.37
|
| Rate for Payer: UHCCP Medicaid |
$12.75
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.52
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$12.00
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
