|
HC BURN R&B
|
Facility
|
IP
|
$7,438.86
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$4,835.26 |
| Max. Negotiated Rate |
$7,438.86 |
| Rate for Payer: Aetna Commercial |
$6,694.97
|
| Rate for Payer: ASR ASR |
$7,215.69
|
| Rate for Payer: ASR Commercial |
$7,215.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,061.93
|
| Rate for Payer: BCN Commercial |
$5,767.35
|
| Rate for Payer: Cash Price |
$5,951.09
|
| Rate for Payer: Cofinity Commercial |
$6,992.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,951.09
|
| Rate for Payer: Healthscope Commercial |
$7,438.86
|
| Rate for Payer: Healthscope Whirlpool |
$7,215.69
|
| Rate for Payer: Mclaren Commercial |
$6,694.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,323.03
|
| Rate for Payer: Nomi Health Commercial |
$6,099.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,835.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,546.20
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$223.87
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$223.87 |
| Rate for Payer: Aetna Commercial |
$201.48
|
| Rate for Payer: Aetna Medicare |
$111.94
|
| Rate for Payer: ASR ASR |
$217.15
|
| Rate for Payer: ASR Commercial |
$217.15
|
| Rate for Payer: BCBS Complete |
$89.55
|
| Rate for Payer: BCBS Trust/PPO |
$183.33
|
| Rate for Payer: BCN Commercial |
$173.57
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cofinity Commercial |
$210.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.10
|
| Rate for Payer: Healthscope Commercial |
$223.87
|
| Rate for Payer: Healthscope Whirlpool |
$217.15
|
| Rate for Payer: Mclaren Commercial |
$201.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.29
|
| Rate for Payer: Nomi Health Commercial |
$183.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.15
|
| Rate for Payer: Priority Health Narrow Network |
$156.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.01
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$223.87
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$223.87 |
| Rate for Payer: Aetna Commercial |
$201.48
|
| Rate for Payer: ASR ASR |
$217.15
|
| Rate for Payer: ASR Commercial |
$217.15
|
| Rate for Payer: BCBS Trust/PPO |
$182.43
|
| Rate for Payer: BCN Commercial |
$173.57
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cofinity Commercial |
$210.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.10
|
| Rate for Payer: Healthscope Commercial |
$223.87
|
| Rate for Payer: Healthscope Whirlpool |
$217.15
|
| Rate for Payer: Mclaren Commercial |
$201.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.29
|
| Rate for Payer: Nomi Health Commercial |
$183.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.01
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$98.81 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| 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 |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| 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 |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.81
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$79.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
IP
|
$74.51
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.43 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna Commercial |
$67.06
|
| Rate for Payer: ASR ASR |
$72.27
|
| Rate for Payer: ASR Commercial |
$72.27
|
| Rate for Payer: BCBS Trust/PPO |
$60.72
|
| Rate for Payer: BCN Commercial |
$57.77
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.61
|
| Rate for Payer: Healthscope Commercial |
$74.51
|
| Rate for Payer: Healthscope Whirlpool |
$72.27
|
| Rate for Payer: Mclaren Commercial |
$67.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Nomi Health Commercial |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.57
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$74.51
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$67.06
|
| 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 |
$72.27
|
| Rate for Payer: ASR Commercial |
$72.27
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$61.02
|
| Rate for Payer: BCN Commercial |
$57.77
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$74.51
|
| Rate for Payer: Healthscope Whirlpool |
$72.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$67.06
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| 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 |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Nomi Health Commercial |
$61.10
|
| 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 |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC C1Q BINDING
|
Facility
|
IP
|
$113.22
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| Rate for Payer: ASR ASR |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
|
|
HC C1Q BINDING
|
Facility
|
OP
|
$113.22
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| 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 |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Complete |
$13.72
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$92.72
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.37
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Mclaren Medicaid |
$13.06
|
| 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 |
$13.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| 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 |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.20
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health Narrow Network |
$79.37
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.37
|
| Rate for Payer: UHC Exchange |
$37.77
|
| Rate for Payer: UHC Medicare Advantage |
$24.37
|
| Rate for Payer: UHCCP DNSP |
$24.37
|
| Rate for Payer: UHCCP Medicaid |
$13.06
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| 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 |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| 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 |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$76.13
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$98.81 |
| Rate for Payer: Aetna Commercial |
$68.52
|
| 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 |
$73.85
|
| Rate for Payer: ASR Commercial |
$73.85
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.02
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$71.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$76.13
|
| Rate for Payer: Healthscope Whirlpool |
$73.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$68.52
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.71
|
| Rate for Payer: Nomi Health Commercial |
$62.43
|
| 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 |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.81
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$79.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$76.13
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$76.13 |
| Rate for Payer: Aetna Commercial |
$68.52
|
| Rate for Payer: ASR ASR |
$73.85
|
| Rate for Payer: ASR Commercial |
$73.85
|
| Rate for Payer: BCBS Trust/PPO |
$62.04
|
| Rate for Payer: BCN Commercial |
$59.02
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$71.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$76.13
|
| Rate for Payer: Healthscope Whirlpool |
$73.85
|
| Rate for Payer: Mclaren Commercial |
$68.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.71
|
| Rate for Payer: Nomi Health Commercial |
$62.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.99
|
|
|
HC CA 125
|
Facility
|
IP
|
$145.96
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.87 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$131.36
|
| Rate for Payer: ASR ASR |
$141.58
|
| Rate for Payer: ASR Commercial |
$141.58
|
| Rate for Payer: BCBS Trust/PPO |
$118.94
|
| Rate for Payer: BCN Commercial |
$113.16
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.77
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Mclaren Commercial |
$131.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.07
|
| Rate for Payer: Nomi Health Commercial |
$119.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.44
|
|
|
HC CA 125
|
Facility
|
OP
|
$145.96
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$131.36
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: ASR ASR |
$141.58
|
| Rate for Payer: ASR Commercial |
$141.58
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$119.53
|
| Rate for Payer: BCN Commercial |
$113.16
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$131.36
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.07
|
| Rate for Payer: Nomi Health Commercial |
$119.69
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Medicaid |
$11.15
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP DNSP |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$11.15
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Medicare |
$23.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.55
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: ASR Commercial |
$47.18
|
| Rate for Payer: BCBS Complete |
$13.30
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$39.83
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Healthscope Whirlpool |
$47.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.64
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Mclaren Medicaid |
$12.67
|
| Rate for Payer: Mclaren Medicare |
$23.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: Meridian Medicaid |
$13.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE Medicare |
$22.46
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Commercial |
$26.00
|
| Rate for Payer: PHP Medicaid |
$12.67
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.62
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow Network |
$34.10
|
| Rate for Payer: Railroad Medicare Medicare |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.64
|
| Rate for Payer: UHC Exchange |
$36.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.64
|
| Rate for Payer: UHCCP DNSP |
$23.64
|
| Rate for Payer: UHCCP Medicaid |
$12.67
|
| Rate for Payer: VA VA |
$23.64
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: ASR Commercial |
$47.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.64
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Healthscope Whirlpool |
$47.18
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: ASR Commercial |
$114.04
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$96.28
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Healthscope Whirlpool |
$114.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.82
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$11.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: ASR Commercial |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$95.81
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Healthscope Whirlpool |
$114.04
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$136.15 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.49
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$15.08
|
| Rate for Payer: BCBS MAPPO |
$26.79
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.79
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.79
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$14.36
|
| Rate for Payer: Mclaren Medicare |
$26.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.13
|
| Rate for Payer: Meridian Medicaid |
$15.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: PACE Medicare |
$25.45
|
| Rate for Payer: PACE SWMI |
$26.79
|
| Rate for Payer: PHP Commercial |
$29.47
|
| Rate for Payer: PHP Medicaid |
$14.36
|
| Rate for Payer: PHP Medicare Advantage |
$26.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.15
|
| Rate for Payer: Priority Health Medicare |
$26.79
|
| Rate for Payer: Priority Health Narrow Network |
$108.92
|
| Rate for Payer: Railroad Medicare Medicare |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.79
|
| Rate for Payer: UHC Exchange |
$41.52
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: UHCCP DNSP |
$26.79
|
| Rate for Payer: UHCCP Medicaid |
$14.36
|
| Rate for Payer: VA VA |
$26.79
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
IP
|
$26.88
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$26.07
|
| Rate for Payer: ASR Commercial |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.90
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$26.88
|
| Rate for Payer: Healthscope Whirlpool |
$26.07
|
| Rate for Payer: Mclaren Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Nomi Health Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.65
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
OP
|
$26.88
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: ASR ASR |
$26.07
|
| Rate for Payer: ASR Commercial |
$26.07
|
| Rate for Payer: BCBS Complete |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$22.01
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$26.88
|
| Rate for Payer: Healthscope Whirlpool |
$26.07
|
| Rate for Payer: Mclaren Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Nomi Health Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.55
|
| Rate for Payer: Priority Health Narrow Network |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.65
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
OP
|
$18.88
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.54
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
IP
|
$18.88
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
