|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.05 |
| Max. Negotiated Rate |
$483.16 |
| Rate for Payer: Aetna Commercial |
$434.84
|
| Rate for Payer: ASR ASR |
$468.67
|
| Rate for Payer: ASR Commercial |
$468.67
|
| Rate for Payer: BCBS Trust/PPO |
$393.73
|
| Rate for Payer: BCN Commercial |
$374.59
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$454.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Healthscope Commercial |
$483.16
|
| Rate for Payer: Healthscope Whirlpool |
$468.67
|
| Rate for Payer: Mclaren Commercial |
$434.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: Nomi Health Commercial |
$396.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.18
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$501.41 |
| Rate for Payer: Aetna Commercial |
$434.84
|
| Rate for Payer: Aetna Medicare |
$323.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: ASR ASR |
$468.67
|
| Rate for Payer: ASR Commercial |
$468.67
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCBS Trust/PPO |
$395.66
|
| Rate for Payer: BCN Commercial |
$374.59
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$454.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$483.16
|
| Rate for Payer: Healthscope Whirlpool |
$468.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.49
|
| Rate for Payer: Mclaren Commercial |
$434.84
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: Nomi Health Commercial |
$396.19
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: PHP Medicaid |
$173.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.34
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health Narrow Network |
$338.70
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$501.41
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP DNSP |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna Commercial |
$129.04
|
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: ASR ASR |
$139.08
|
| Rate for Payer: ASR Commercial |
$139.08
|
| Rate for Payer: BCBS Complete |
$57.35
|
| Rate for Payer: BCBS Trust/PPO |
$117.41
|
| Rate for Payer: BCN Commercial |
$111.16
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$134.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$143.38
|
| Rate for Payer: Healthscope Whirlpool |
$139.08
|
| Rate for Payer: Mclaren Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: Nomi Health Commercial |
$117.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.63
|
| Rate for Payer: Priority Health Narrow Network |
$100.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.17
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna Commercial |
$129.04
|
| Rate for Payer: ASR ASR |
$139.08
|
| Rate for Payer: ASR Commercial |
$139.08
|
| Rate for Payer: BCBS Trust/PPO |
$116.84
|
| Rate for Payer: BCN Commercial |
$111.16
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$134.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$143.38
|
| Rate for Payer: Healthscope Whirlpool |
$139.08
|
| Rate for Payer: Mclaren Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: Nomi Health Commercial |
$117.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.17
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$823.25 |
| Rate for Payer: Aetna Commercial |
$740.92
|
| Rate for Payer: Aetna Medicare |
$411.62
|
| Rate for Payer: ASR ASR |
$798.55
|
| Rate for Payer: ASR Commercial |
$798.55
|
| Rate for Payer: BCBS Complete |
$329.30
|
| Rate for Payer: BCBS Trust/PPO |
$674.16
|
| Rate for Payer: BCN Commercial |
$638.27
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$773.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$823.25
|
| Rate for Payer: Healthscope Whirlpool |
$798.55
|
| Rate for Payer: Mclaren Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: Nomi Health Commercial |
$675.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.33
|
| Rate for Payer: Priority Health Narrow Network |
$577.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$724.46
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$535.11 |
| Max. Negotiated Rate |
$823.25 |
| Rate for Payer: Aetna Commercial |
$740.92
|
| Rate for Payer: ASR ASR |
$798.55
|
| Rate for Payer: ASR Commercial |
$798.55
|
| Rate for Payer: BCBS Trust/PPO |
$670.87
|
| Rate for Payer: BCN Commercial |
$638.27
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$773.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$823.25
|
| Rate for Payer: Healthscope Whirlpool |
$798.55
|
| Rate for Payer: Mclaren Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: Nomi Health Commercial |
$675.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$724.46
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,070.21 |
| Max. Negotiated Rate |
$1,646.48 |
| Rate for Payer: Aetna Commercial |
$1,481.83
|
| Rate for Payer: ASR ASR |
$1,597.09
|
| Rate for Payer: ASR Commercial |
$1,597.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.72
|
| Rate for Payer: BCN Commercial |
$1,276.52
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,547.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,646.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Mclaren Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.90
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$658.59 |
| Max. Negotiated Rate |
$1,646.48 |
| Rate for Payer: Aetna Commercial |
$1,481.83
|
| Rate for Payer: Aetna Medicare |
$823.24
|
| Rate for Payer: ASR ASR |
$1,597.09
|
| Rate for Payer: ASR Commercial |
$1,597.09
|
| Rate for Payer: BCBS Complete |
$658.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.30
|
| Rate for Payer: BCN Commercial |
$1,276.52
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,547.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,646.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Mclaren Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,442.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.90
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.47 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: ASR Commercial |
$287.22
|
| Rate for Payer: BCBS Trust/PPO |
$241.29
|
| Rate for Payer: BCN Commercial |
$229.57
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: ASR Commercial |
$287.22
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$242.48
|
| Rate for Payer: BCN Commercial |
$229.57
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.44
|
| Rate for Payer: Priority Health Narrow Network |
$207.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: ASR Commercial |
$287.22
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$242.48
|
| Rate for Payer: BCN Commercial |
$229.57
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.44
|
| Rate for Payer: Priority Health Narrow Network |
$207.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.47 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: ASR Commercial |
$287.22
|
| Rate for Payer: BCBS Trust/PPO |
$241.29
|
| Rate for Payer: BCN Commercial |
$229.57
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: ASR ASR |
$6.05
|
| Rate for Payer: ASR Commercial |
$6.05
|
| Rate for Payer: BCBS Trust/PPO |
$5.08
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$6.24
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.49
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: ASR ASR |
$6.05
|
| Rate for Payer: ASR Commercial |
$6.05
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$6.24
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.45
|
| Rate for Payer: Mclaren Commercial |
$5.62
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE Medicare |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: PHP Medicaid |
$2.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.47
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health Narrow Network |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Exchange |
$6.90
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP DNSP |
$4.45
|
| Rate for Payer: UHCCP Medicaid |
$2.39
|
| Rate for Payer: VA VA |
$4.45
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$341.74 |
| Max. Negotiated Rate |
$988.25 |
| Rate for Payer: Aetna Commercial |
$849.65
|
| Rate for Payer: Aetna Medicare |
$637.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.98
|
| Rate for Payer: ASR ASR |
$915.74
|
| Rate for Payer: ASR Commercial |
$915.74
|
| Rate for Payer: BCBS Complete |
$358.83
|
| Rate for Payer: BCBS MAPPO |
$637.58
|
| Rate for Payer: BCBS Trust/PPO |
$773.09
|
| Rate for Payer: BCN Commercial |
$731.93
|
| Rate for Payer: BCN Medicare Advantage |
$637.58
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$887.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.58
|
| Rate for Payer: Healthscope Commercial |
$944.06
|
| Rate for Payer: Healthscope Whirlpool |
$915.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.58
|
| Rate for Payer: Mclaren Commercial |
$849.65
|
| Rate for Payer: Mclaren Medicaid |
$341.74
|
| Rate for Payer: Mclaren Medicare |
$637.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.46
|
| Rate for Payer: Meridian Medicaid |
$358.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$774.13
|
| Rate for Payer: PACE Medicare |
$605.70
|
| Rate for Payer: PACE SWMI |
$637.58
|
| Rate for Payer: PHP Commercial |
$701.34
|
| Rate for Payer: PHP Medicaid |
$341.74
|
| Rate for Payer: PHP Medicare Advantage |
$637.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.19
|
| Rate for Payer: Priority Health Medicare |
$637.58
|
| Rate for Payer: Priority Health Narrow Network |
$661.79
|
| Rate for Payer: Railroad Medicare Medicare |
$637.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.58
|
| Rate for Payer: UHC Exchange |
$988.25
|
| Rate for Payer: UHC Medicare Advantage |
$637.58
|
| Rate for Payer: UHCCP DNSP |
$637.58
|
| Rate for Payer: UHCCP Medicaid |
$341.74
|
| Rate for Payer: VA VA |
$637.58
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$613.64 |
| Max. Negotiated Rate |
$944.06 |
| Rate for Payer: Aetna Commercial |
$849.65
|
| Rate for Payer: ASR ASR |
$915.74
|
| Rate for Payer: ASR Commercial |
$915.74
|
| Rate for Payer: BCBS Trust/PPO |
$769.31
|
| Rate for Payer: BCN Commercial |
$731.93
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$887.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Healthscope Commercial |
$944.06
|
| Rate for Payer: Healthscope Whirlpool |
$915.74
|
| Rate for Payer: Mclaren Commercial |
$849.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$774.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.77
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,684.55
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$5,048.91
|
| Rate for Payer: ASR Commercial |
$5,048.91
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,262.42
|
| Rate for Payer: BCN Commercial |
$4,035.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,892.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,048.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$4,684.55
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,560.67
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,648.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,580.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,383.29 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,684.55
|
| Rate for Payer: ASR ASR |
$5,048.91
|
| Rate for Payer: ASR Commercial |
$5,048.91
|
| Rate for Payer: BCBS Trust/PPO |
$4,241.60
|
| Rate for Payer: BCN Commercial |
$4,035.48
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,892.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,048.91
|
| Rate for Payer: Mclaren Commercial |
$4,684.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,580.45
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$989.21 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: Aetna Medicare |
$638.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.75
|
| Rate for Payer: ASR ASR |
$812.08
|
| Rate for Payer: ASR Commercial |
$812.08
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCBS Trust/PPO |
$685.58
|
| Rate for Payer: BCN Commercial |
$649.08
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$786.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Healthscope Commercial |
$837.20
|
| Rate for Payer: Healthscope Whirlpool |
$812.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$638.20
|
| Rate for Payer: Mclaren Commercial |
$753.48
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Mclaren Medicare |
$638.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.11
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: PACE Medicare |
$606.29
|
| Rate for Payer: PACE SWMI |
$638.20
|
| Rate for Payer: PHP Commercial |
$702.02
|
| Rate for Payer: PHP Medicaid |
$342.08
|
| Rate for Payer: PHP Medicare Advantage |
$638.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.55
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Priority Health Narrow Network |
$586.88
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$736.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.20
|
| Rate for Payer: UHC Exchange |
$989.21
|
| Rate for Payer: UHC Medicare Advantage |
$638.20
|
| Rate for Payer: UHCCP DNSP |
$638.20
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
| Rate for Payer: VA VA |
$638.20
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$544.18 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: ASR ASR |
$812.08
|
| Rate for Payer: ASR Commercial |
$812.08
|
| Rate for Payer: BCBS Trust/PPO |
$682.23
|
| Rate for Payer: BCN Commercial |
$649.08
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$786.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$837.20
|
| Rate for Payer: Healthscope Whirlpool |
$812.08
|
| Rate for Payer: Mclaren Commercial |
$753.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$736.74
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$307.46 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: Aetna Medicare |
$198.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCBS Trust/PPO |
$200.57
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$198.36
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicaid |
$106.32
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.61
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health Narrow Network |
$171.70
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$307.46
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP DNSP |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$244.93 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Trust/PPO |
$199.59
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$586.39 |
| Rate for Payer: Aetna Commercial |
$527.75
|
| Rate for Payer: ASR ASR |
$568.80
|
| Rate for Payer: ASR Commercial |
$568.80
|
| Rate for Payer: BCBS Trust/PPO |
$477.85
|
| Rate for Payer: BCN Commercial |
$454.63
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$551.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Healthscope Commercial |
$586.39
|
| Rate for Payer: Healthscope Whirlpool |
$568.80
|
| Rate for Payer: Mclaren Commercial |
$527.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.02
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$586.39 |
| Rate for Payer: Aetna Commercial |
$527.75
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$568.80
|
| Rate for Payer: ASR Commercial |
$568.80
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$480.19
|
| Rate for Payer: BCN Commercial |
$454.63
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$551.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$586.39
|
| Rate for Payer: Healthscope Whirlpool |
$568.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$527.75
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.79
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$411.06
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$505.67
|
| Rate for Payer: ASR ASR |
$545.00
|
| Rate for Payer: ASR Commercial |
$545.00
|
| Rate for Payer: BCBS Trust/PPO |
$457.86
|
| Rate for Payer: BCN Commercial |
$435.61
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$528.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: Healthscope Whirlpool |
$545.00
|
| Rate for Payer: Mclaren Commercial |
$505.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.44
|
|
