|
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
|
OP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,120.29 |
| Rate for Payer: Aetna Commercial |
$1,008.26
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,086.68
|
| Rate for Payer: ASR Commercial |
$1,086.68
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$917.41
|
| Rate for Payer: BCN Commercial |
$868.56
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,120.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,086.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,008.26
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$918.64
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| 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 |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$785.32
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$985.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,506.92 |
| Rate for Payer: Aetna Commercial |
$2,256.23
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,431.71
|
| Rate for Payer: ASR Commercial |
$2,431.71
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.92
|
| Rate for Payer: BCN Commercial |
$1,943.62
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,506.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,431.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,256.23
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| 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 |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| 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 |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,757.35
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,206.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$785.92 |
| Rate for Payer: Aetna Commercial |
$707.33
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$762.34
|
| Rate for Payer: ASR Commercial |
$762.34
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$643.59
|
| Rate for Payer: BCN Commercial |
$609.32
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$785.92
|
| Rate for Payer: Healthscope Whirlpool |
$762.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$707.33
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$644.45
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| 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 |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$550.93
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$157.91
|
| 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 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 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 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 |
$202.03
|
| 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 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
|
|
|
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 SPHINCTEROTOMY
|
Facility
|
IP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,629.84 |
| Max. Negotiated Rate |
$4,045.90 |
| Rate for Payer: Aetna Commercial |
$3,641.31
|
| Rate for Payer: ASR ASR |
$3,924.52
|
| Rate for Payer: ASR Commercial |
$3,924.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,297.00
|
| Rate for Payer: BCN Commercial |
$3,136.79
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,803.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$4,045.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.52
|
| Rate for Payer: Mclaren Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,560.39
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,618.36 |
| Max. Negotiated Rate |
$4,045.90 |
| Rate for Payer: Aetna Commercial |
$3,641.31
|
| Rate for Payer: Aetna Medicare |
$2,022.95
|
| Rate for Payer: ASR ASR |
$3,924.52
|
| Rate for Payer: ASR Commercial |
$3,924.52
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,313.19
|
| Rate for Payer: BCN Commercial |
$3,136.79
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,803.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$4,045.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.52
|
| Rate for Payer: Mclaren Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,545.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,836.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,560.39
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$895.36 |
| Rate for Payer: Aetna Commercial |
$805.82
|
| Rate for Payer: ASR ASR |
$868.50
|
| Rate for Payer: ASR Commercial |
$868.50
|
| Rate for Payer: BCBS Trust/PPO |
$729.63
|
| Rate for Payer: BCN Commercial |
$694.17
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$841.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Healthscope Commercial |
$895.36
|
| Rate for Payer: Healthscope Whirlpool |
$868.50
|
| Rate for Payer: Mclaren Commercial |
$805.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: Nomi Health Commercial |
$734.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.92
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
OP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.14 |
| Max. Negotiated Rate |
$895.36 |
| Rate for Payer: Aetna Commercial |
$805.82
|
| Rate for Payer: Aetna Medicare |
$447.68
|
| Rate for Payer: ASR ASR |
$868.50
|
| Rate for Payer: ASR Commercial |
$868.50
|
| Rate for Payer: BCBS Complete |
$358.14
|
| Rate for Payer: BCBS Trust/PPO |
$733.21
|
| Rate for Payer: BCN Commercial |
$694.17
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$841.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Healthscope Commercial |
$895.36
|
| Rate for Payer: Healthscope Whirlpool |
$868.50
|
| Rate for Payer: Mclaren Commercial |
$805.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: Nomi Health Commercial |
$734.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.51
|
| Rate for Payer: Priority Health Narrow Network |
$627.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.92
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,231.81 |
| Max. Negotiated Rate |
$3,433.56 |
| Rate for Payer: Aetna Commercial |
$3,090.20
|
| Rate for Payer: ASR ASR |
$3,330.55
|
| Rate for Payer: ASR Commercial |
$3,330.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,798.01
|
| Rate for Payer: BCN Commercial |
$2,662.04
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$3,227.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Healthscope Commercial |
$3,433.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,330.55
|
| Rate for Payer: Mclaren Commercial |
$3,090.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: Nomi Health Commercial |
$2,815.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,021.53
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.47 |
| Max. Negotiated Rate |
$3,433.56 |
| Rate for Payer: Aetna Commercial |
$3,090.20
|
| Rate for Payer: Aetna Medicare |
$821.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,027.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,027.22
|
| Rate for Payer: ASR ASR |
$3,330.55
|
| Rate for Payer: ASR Commercial |
$3,330.55
|
| Rate for Payer: BCBS Complete |
$462.50
|
| Rate for Payer: BCBS MAPPO |
$821.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,811.74
|
| Rate for Payer: BCN Commercial |
$2,662.04
|
| Rate for Payer: BCN Medicare Advantage |
$821.78
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$3,227.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.78
|
| Rate for Payer: Healthscope Commercial |
$3,433.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,330.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$821.78
|
| Rate for Payer: Mclaren Commercial |
$3,090.20
|
| Rate for Payer: Mclaren Medicaid |
$440.47
|
| Rate for Payer: Mclaren Medicare |
$821.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.87
|
| Rate for Payer: Meridian Medicaid |
$462.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$945.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: Nomi Health Commercial |
$2,815.52
|
| Rate for Payer: PACE Medicare |
$780.69
|
| Rate for Payer: PACE SWMI |
$821.78
|
| Rate for Payer: PHP Commercial |
$903.96
|
| Rate for Payer: PHP Medicaid |
$440.47
|
| Rate for Payer: PHP Medicare Advantage |
$821.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,008.49
|
| Rate for Payer: Priority Health Medicare |
$821.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,406.93
|
| Rate for Payer: Railroad Medicare Medicare |
$821.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,021.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.78
|
| Rate for Payer: UHC Exchange |
$1,273.76
|
| Rate for Payer: UHC Medicare Advantage |
$821.78
|
| Rate for Payer: UHCCP DNSP |
$821.78
|
| Rate for Payer: UHCCP Medicaid |
$440.47
|
| Rate for Payer: VA VA |
$821.78
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$2,047.66 |
| Rate for Payer: Aetna Commercial |
$1,842.89
|
| Rate for Payer: Aetna Medicare |
$597.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$747.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$747.42
|
| Rate for Payer: ASR ASR |
$1,986.23
|
| Rate for Payer: ASR Commercial |
$1,986.23
|
| Rate for Payer: BCBS Complete |
$336.52
|
| Rate for Payer: BCBS MAPPO |
$597.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.83
|
| Rate for Payer: BCN Commercial |
$1,587.55
|
| Rate for Payer: BCN Medicare Advantage |
$597.94
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,924.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.94
|
| Rate for Payer: Healthscope Commercial |
$2,047.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,986.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.94
|
| Rate for Payer: Mclaren Commercial |
$1,842.89
|
| Rate for Payer: Mclaren Medicaid |
$320.50
|
| Rate for Payer: Mclaren Medicare |
$597.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.84
|
| Rate for Payer: Meridian Medicaid |
$336.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$687.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: Nomi Health Commercial |
$1,679.08
|
| Rate for Payer: PACE Medicare |
$568.04
|
| Rate for Payer: PACE SWMI |
$597.94
|
| Rate for Payer: PHP Commercial |
$657.73
|
| Rate for Payer: PHP Medicaid |
$320.50
|
| Rate for Payer: PHP Medicare Advantage |
$597.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,794.16
|
| Rate for Payer: Priority Health Medicare |
$597.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,435.41
|
| Rate for Payer: Railroad Medicare Medicare |
$597.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,801.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.94
|
| Rate for Payer: UHC Exchange |
$926.81
|
| Rate for Payer: UHC Medicare Advantage |
$597.94
|
| Rate for Payer: UHCCP DNSP |
$597.94
|
| Rate for Payer: UHCCP Medicaid |
$320.50
|
| Rate for Payer: VA VA |
$597.94
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,330.98 |
| Max. Negotiated Rate |
$2,047.66 |
| Rate for Payer: Aetna Commercial |
$1,842.89
|
| Rate for Payer: ASR ASR |
$1,986.23
|
| Rate for Payer: ASR Commercial |
$1,986.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.64
|
| Rate for Payer: BCN Commercial |
$1,587.55
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,924.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Healthscope Commercial |
$2,047.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,986.23
|
| Rate for Payer: Mclaren Commercial |
$1,842.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: Nomi Health Commercial |
$1,679.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,801.94
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,419.01 |
| Rate for Payer: Aetna Commercial |
$1,277.11
|
| Rate for Payer: Aetna Medicare |
$415.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: ASR ASR |
$1,376.44
|
| Rate for Payer: ASR Commercial |
$1,376.44
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.03
|
| Rate for Payer: BCN Commercial |
$1,100.16
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,333.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.29
|
| Rate for Payer: Healthscope Commercial |
$1,419.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$415.29
|
| Rate for Payer: Mclaren Commercial |
$1,277.11
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: Nomi Health Commercial |
$1,163.59
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Commercial |
$456.82
|
| Rate for Payer: PHP Medicaid |
$222.60
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.34
|
| Rate for Payer: Priority Health Medicare |
$415.29
|
| Rate for Payer: Priority Health Narrow Network |
$994.73
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,248.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Exchange |
$643.70
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP DNSP |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$222.60
|
| Rate for Payer: VA VA |
$415.29
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$922.36 |
| Max. Negotiated Rate |
$1,419.01 |
| Rate for Payer: Aetna Commercial |
$1,277.11
|
| Rate for Payer: ASR ASR |
$1,376.44
|
| Rate for Payer: ASR Commercial |
$1,376.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.35
|
| Rate for Payer: BCN Commercial |
$1,100.16
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,333.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Healthscope Commercial |
$1,419.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.44
|
| Rate for Payer: Mclaren Commercial |
$1,277.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: Nomi Health Commercial |
$1,163.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,248.73
|
|
