|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$37,256.20 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: Aetna Medicare |
$24,036.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,045.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,045.32
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Complete |
$13,527.61
|
| Rate for Payer: BCBS MAPPO |
$24,036.26
|
| Rate for Payer: BCBS Trust/PPO |
$7,289.85
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: BCN Medicare Advantage |
$24,036.26
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,036.26
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,036.26
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Mclaren Medicaid |
$12,883.44
|
| Rate for Payer: Mclaren Medicare |
$24,036.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,238.07
|
| Rate for Payer: Meridian Medicaid |
$13,527.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,641.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Medicare |
$22,834.45
|
| Rate for Payer: PACE SWMI |
$24,036.26
|
| Rate for Payer: PHP Commercial |
$26,439.89
|
| Rate for Payer: PHP Medicaid |
$12,883.44
|
| Rate for Payer: PHP Medicare Advantage |
$24,036.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,883.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,760.73
|
| Rate for Payer: Priority Health Medicare |
$24,036.26
|
| Rate for Payer: Priority Health Narrow Network |
$10,208.58
|
| Rate for Payer: Railroad Medicare Medicare |
$24,036.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,833.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,036.26
|
| Rate for Payer: UHC Exchange |
$37,256.20
|
| Rate for Payer: UHC Medicare Advantage |
$24,036.26
|
| Rate for Payer: UHCCP DNSP |
$24,036.26
|
| Rate for Payer: UHCCP Medicaid |
$12,883.44
|
| Rate for Payer: VA VA |
$24,036.26
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$120.77 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.77
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$96.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$120.77 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.77
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$96.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.29
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$16.82
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Exchange |
$23.70
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP DNSP |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$45.01 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.40
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.12
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.43
|
| Rate for Payer: PHP Medicaid |
$7.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.01
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health Narrow Network |
$36.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.12
|
| Rate for Payer: UHC Exchange |
$20.34
|
| Rate for Payer: UHC Medicare Advantage |
$13.12
|
| Rate for Payer: UHCCP DNSP |
$13.12
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: ASR Commercial |
$118.08
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$99.68
|
| Rate for Payer: BCN Commercial |
$94.38
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.66
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$85.33
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: ASR Commercial |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$99.20
|
| Rate for Payer: BCN Commercial |
$94.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: ASR Commercial |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$99.20
|
| Rate for Payer: BCN Commercial |
$94.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: ASR Commercial |
$118.08
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$99.68
|
| Rate for Payer: BCN Commercial |
$94.38
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.66
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$85.33
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.96
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$728.19 |
| Max. Negotiated Rate |
$1,120.29 |
| Rate for Payer: Aetna Commercial |
$1,008.26
|
| Rate for Payer: ASR ASR |
$1,086.68
|
| Rate for Payer: ASR Commercial |
$1,086.68
|
| Rate for Payer: BCBS Trust/PPO |
$912.92
|
| Rate for Payer: BCN Commercial |
$868.56
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$1,053.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Healthscope Commercial |
$1,120.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,086.68
|
| Rate for Payer: Mclaren Commercial |
$1,008.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$918.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$985.86
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,120.29 |
| Rate for Payer: Aetna Commercial |
$1,008.26
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$1,086.68
|
| Rate for Payer: ASR Commercial |
$1,086.68
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$917.41
|
| Rate for Payer: BCN Commercial |
$868.56
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$1,053.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,120.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,086.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$1,008.26
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$918.64
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$981.60
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$785.32
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$985.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,506.92 |
| Rate for Payer: Aetna Commercial |
$2,256.23
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$2,431.71
|
| Rate for Payer: ASR Commercial |
$2,431.71
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.92
|
| Rate for Payer: BCN Commercial |
$1,943.62
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,506.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,431.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$2,256.23
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: Nomi Health Commercial |
$2,055.67
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,196.56
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,757.35
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,206.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,629.50 |
| Max. Negotiated Rate |
$2,506.92 |
| Rate for Payer: Aetna Commercial |
$2,256.23
|
| Rate for Payer: ASR ASR |
$2,431.71
|
| Rate for Payer: ASR Commercial |
$2,431.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.89
|
| Rate for Payer: BCN Commercial |
$1,943.62
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Healthscope Commercial |
$2,506.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,431.71
|
| Rate for Payer: Mclaren Commercial |
$2,256.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: Nomi Health Commercial |
$2,055.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,206.09
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$785.92 |
| Rate for Payer: Aetna Commercial |
$707.33
|
| Rate for Payer: ASR ASR |
$762.34
|
| Rate for Payer: ASR Commercial |
$762.34
|
| Rate for Payer: BCBS Trust/PPO |
$640.45
|
| Rate for Payer: BCN Commercial |
$609.32
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$738.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Healthscope Commercial |
$785.92
|
| Rate for Payer: Healthscope Whirlpool |
$762.34
|
| Rate for Payer: Mclaren Commercial |
$707.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$644.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.61
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$785.92 |
| Rate for Payer: Aetna Commercial |
$707.33
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$762.34
|
| Rate for Payer: ASR Commercial |
$762.34
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$643.59
|
| Rate for Payer: BCN Commercial |
$609.32
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$738.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$785.92
|
| Rate for Payer: Healthscope Whirlpool |
$762.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$707.33
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$644.45
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.62
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$550.93
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC ERBE IRRIGATION
|
Facility
|
IP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$205.29 |
| Max. Negotiated Rate |
$315.83 |
| Rate for Payer: Aetna Commercial |
$284.25
|
| Rate for Payer: ASR ASR |
$306.36
|
| Rate for Payer: ASR Commercial |
$306.36
|
| Rate for Payer: BCBS Trust/PPO |
$257.37
|
| Rate for Payer: BCN Commercial |
$244.86
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$296.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$315.83
|
| Rate for Payer: Healthscope Whirlpool |
$306.36
|
| Rate for Payer: Mclaren Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: Nomi Health Commercial |
$258.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.93
|
|
|
HC ERBE IRRIGATION
|
Facility
|
OP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$315.83 |
| Rate for Payer: Aetna Commercial |
$284.25
|
| Rate for Payer: Aetna Medicare |
$157.92
|
| Rate for Payer: ASR ASR |
$306.36
|
| Rate for Payer: ASR Commercial |
$306.36
|
| Rate for Payer: BCBS Complete |
$126.33
|
| Rate for Payer: BCBS Trust/PPO |
$258.63
|
| Rate for Payer: BCN Commercial |
$244.86
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$296.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$315.83
|
| Rate for Payer: Healthscope Whirlpool |
$306.36
|
| Rate for Payer: Mclaren Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: Nomi Health Commercial |
$258.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.73
|
| Rate for Payer: Priority Health Narrow Network |
$221.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.93
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.63 |
| Max. Negotiated Rate |
$404.07 |
| Rate for Payer: Aetna Commercial |
$363.66
|
| Rate for Payer: Aetna Medicare |
$202.04
|
| Rate for Payer: ASR ASR |
$391.95
|
| Rate for Payer: ASR Commercial |
$391.95
|
| Rate for Payer: BCBS Complete |
$161.63
|
| Rate for Payer: BCBS Trust/PPO |
$330.89
|
| Rate for Payer: BCN Commercial |
$313.28
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$379.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$404.07
|
| Rate for Payer: Healthscope Whirlpool |
$391.95
|
| Rate for Payer: Mclaren Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: Nomi Health Commercial |
$331.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.05
|
| Rate for Payer: Priority Health Narrow Network |
$283.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.58
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.65 |
| Max. Negotiated Rate |
$404.07 |
| Rate for Payer: Aetna Commercial |
$363.66
|
| Rate for Payer: ASR ASR |
$391.95
|
| Rate for Payer: ASR Commercial |
$391.95
|
| Rate for Payer: BCBS Trust/PPO |
$329.28
|
| Rate for Payer: BCN Commercial |
$313.28
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$379.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$404.07
|
| Rate for Payer: Healthscope Whirlpool |
$391.95
|
| Rate for Payer: Mclaren Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: Nomi Health Commercial |
$331.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.58
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,358.78 |
| Max. Negotiated Rate |
$3,396.96 |
| Rate for Payer: Aetna Commercial |
$3,057.26
|
| Rate for Payer: Aetna Medicare |
$1,698.48
|
| Rate for Payer: ASR ASR |
$3,295.05
|
| Rate for Payer: ASR Commercial |
$3,295.05
|
| Rate for Payer: BCBS Complete |
$1,358.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,781.77
|
| Rate for Payer: BCN Commercial |
$2,633.66
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$3,193.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Healthscope Commercial |
$3,396.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,295.05
|
| Rate for Payer: Mclaren Commercial |
$3,057.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: Nomi Health Commercial |
$2,785.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,976.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,381.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,989.32
|
|
|
HC ERCP
|
Facility
|
IP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,208.02 |
| Max. Negotiated Rate |
$3,396.96 |
| Rate for Payer: Aetna Commercial |
$3,057.26
|
| Rate for Payer: ASR ASR |
$3,295.05
|
| Rate for Payer: ASR Commercial |
$3,295.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,768.18
|
| Rate for Payer: BCN Commercial |
$2,633.66
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$3,193.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Healthscope Commercial |
$3,396.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,295.05
|
| Rate for Payer: Mclaren Commercial |
$3,057.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: Nomi Health Commercial |
$2,785.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,989.32
|
|
