|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$91.13 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$88.40
|
| Rate for Payer: ASR Commercial |
$88.40
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$74.63
|
| Rate for Payer: BCN Commercial |
$70.65
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$91.13
|
| Rate for Payer: Healthscope Whirlpool |
$88.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$82.02
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.85
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$63.88
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$91.13 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: ASR ASR |
$88.40
|
| Rate for Payer: ASR Commercial |
$88.40
|
| Rate for Payer: BCBS Trust/PPO |
$74.26
|
| Rate for Payer: BCN Commercial |
$70.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$91.13
|
| Rate for Payer: Healthscope Whirlpool |
$88.40
|
| Rate for Payer: Mclaren Commercial |
$82.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.19
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$123.65
|
| Rate for Payer: ASR ASR |
$133.27
|
| Rate for Payer: ASR Commercial |
$133.27
|
| Rate for Payer: BCBS Trust/PPO |
$111.96
|
| Rate for Payer: BCN Commercial |
$106.52
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$129.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Healthscope Whirlpool |
$133.27
|
| Rate for Payer: Mclaren Commercial |
$123.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.90
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$123.65
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$133.27
|
| Rate for Payer: ASR Commercial |
$133.27
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$112.51
|
| Rate for Payer: BCN Commercial |
$106.52
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$129.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Healthscope Whirlpool |
$133.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$123.65
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.38
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$96.31
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$576.43 |
| Rate for Payer: Aetna Commercial |
$518.79
|
| Rate for Payer: ASR ASR |
$559.14
|
| Rate for Payer: ASR Commercial |
$559.14
|
| Rate for Payer: BCBS Trust/PPO |
$469.73
|
| Rate for Payer: BCN Commercial |
$446.91
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$541.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Healthscope Commercial |
$576.43
|
| Rate for Payer: Healthscope Whirlpool |
$559.14
|
| Rate for Payer: Mclaren Commercial |
$518.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.26
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$989.21 |
| Rate for Payer: Aetna Commercial |
$518.79
|
| 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 |
$559.14
|
| Rate for Payer: ASR Commercial |
$559.14
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCBS Trust/PPO |
$472.04
|
| Rate for Payer: BCN Commercial |
$446.91
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$541.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Healthscope Commercial |
$576.43
|
| Rate for Payer: Healthscope Whirlpool |
$559.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$638.20
|
| Rate for Payer: Mclaren Commercial |
$518.79
|
| 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 |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| 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 |
$374.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.07
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Priority Health Narrow Network |
$404.08
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.26
|
| 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 EXTERNAL VERSION
|
Facility
|
IP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,844.91 |
| Max. Negotiated Rate |
$2,838.32 |
| Rate for Payer: Aetna Commercial |
$2,554.49
|
| Rate for Payer: ASR ASR |
$2,753.17
|
| Rate for Payer: ASR Commercial |
$2,753.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.95
|
| Rate for Payer: BCN Commercial |
$2,200.55
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,668.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Healthscope Commercial |
$2,838.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,753.17
|
| Rate for Payer: Mclaren Commercial |
$2,554.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,497.72
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$2,554.49
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$2,753.17
|
| Rate for Payer: ASR Commercial |
$2,753.17
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.30
|
| Rate for Payer: BCN Commercial |
$2,200.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,668.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$2,838.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,753.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$2,554.49
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,486.94
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,989.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,497.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Aetna Commercial |
$351.62
|
| Rate for Payer: Aetna Medicare |
$496.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: ASR ASR |
$378.97
|
| Rate for Payer: ASR Commercial |
$378.97
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCBS Trust/PPO |
$319.94
|
| Rate for Payer: BCN Commercial |
$302.90
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$390.69
|
| Rate for Payer: Healthscope Whirlpool |
$378.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$496.66
|
| Rate for Payer: Mclaren Commercial |
$351.62
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Commercial |
$546.33
|
| Rate for Payer: PHP Medicaid |
$266.21
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.32
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Priority Health Narrow Network |
$273.87
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP DNSP |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$390.69 |
| Rate for Payer: Aetna Commercial |
$351.62
|
| Rate for Payer: ASR ASR |
$378.97
|
| Rate for Payer: ASR Commercial |
$378.97
|
| Rate for Payer: BCBS Trust/PPO |
$318.37
|
| Rate for Payer: BCN Commercial |
$302.90
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Healthscope Commercial |
$390.69
|
| Rate for Payer: Healthscope Whirlpool |
$378.97
|
| Rate for Payer: Mclaren Commercial |
$351.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.81
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$127.99 |
| Rate for Payer: Aetna Commercial |
$115.19
|
| Rate for Payer: ASR ASR |
$124.15
|
| Rate for Payer: ASR Commercial |
$124.15
|
| Rate for Payer: BCBS Trust/PPO |
$104.30
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$120.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Healthscope Commercial |
$127.99
|
| Rate for Payer: Healthscope Whirlpool |
$124.15
|
| Rate for Payer: Mclaren Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.63
|
|
|
HC EZPAP SUPPLY
|
Facility
|
OP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$127.99 |
| Rate for Payer: Aetna Commercial |
$115.19
|
| Rate for Payer: Aetna Medicare |
$63.99
|
| Rate for Payer: ASR ASR |
$124.15
|
| Rate for Payer: ASR Commercial |
$124.15
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS Trust/PPO |
$104.81
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$120.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Healthscope Commercial |
$127.99
|
| Rate for Payer: Healthscope Whirlpool |
$124.15
|
| Rate for Payer: Mclaren Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.63
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
IP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$484.74 |
| Rate for Payer: Aetna Commercial |
$436.27
|
| Rate for Payer: ASR ASR |
$470.20
|
| Rate for Payer: ASR Commercial |
$470.20
|
| Rate for Payer: BCBS Trust/PPO |
$395.01
|
| Rate for Payer: BCN Commercial |
$375.82
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$455.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Healthscope Commercial |
$484.74
|
| Rate for Payer: Healthscope Whirlpool |
$470.20
|
| Rate for Payer: Mclaren Commercial |
$436.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.57
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
OP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$484.74 |
| Rate for Payer: Aetna Commercial |
$436.27
|
| Rate for Payer: Aetna Medicare |
$242.37
|
| Rate for Payer: ASR ASR |
$470.20
|
| Rate for Payer: ASR Commercial |
$470.20
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS Trust/PPO |
$396.95
|
| Rate for Payer: BCN Commercial |
$375.82
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$455.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Healthscope Commercial |
$484.74
|
| Rate for Payer: Healthscope Whirlpool |
$470.20
|
| Rate for Payer: Mclaren Commercial |
$436.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.73
|
| Rate for Payer: Priority Health Narrow Network |
$339.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.57
|
|
|
HC F232 OVALBUMIN
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$24.02
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$20.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F232 OVALBUMIN
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
|
HC F233 OVOMUCOID
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$24.02
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$20.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F233 OVOMUCOID
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$25.79
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.59
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$22.07
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$25.79
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.59
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$22.07
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F423 RARA H2 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
|
|
HC F423 RARA H2 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$25.79
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.59
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$22.07
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F424 RARA H3 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200448
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: ASR ASR |
$30.55
|
| Rate for Payer: ASR Commercial |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$31.49
|
| Rate for Payer: Healthscope Whirlpool |
$30.55
|
| Rate for Payer: Mclaren Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.71
|
|
