|
HC MENENCEPH CMPT 5
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$49.25 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.62
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$9.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.70
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$53.36
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.62
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$9.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$157.08
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$157.08 |
| Rate for Payer: Aetna Commercial |
$141.37
|
| Rate for Payer: ASR ASR |
$152.37
|
| Rate for Payer: BCBS Complete |
$62.83
|
| Rate for Payer: BCBS Trust/PPO |
$121.78
|
| Rate for Payer: BCN Commercial |
$121.78
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cofinity Commercial |
$147.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.66
|
| Rate for Payer: Healthscope Commercial |
$157.08
|
| Rate for Payer: Healthscope Whirlpool |
$152.37
|
| Rate for Payer: Mclaren Commercial |
$141.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.94
|
| Rate for Payer: Priority Health Narrow Network |
$111.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.23
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$157.08
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$157.08 |
| Rate for Payer: Aetna Commercial |
$141.37
|
| Rate for Payer: ASR ASR |
$152.37
|
| Rate for Payer: BCBS Trust/PPO |
$121.78
|
| Rate for Payer: BCN Commercial |
$121.78
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cofinity Commercial |
$147.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.66
|
| Rate for Payer: Healthscope Commercial |
$157.08
|
| Rate for Payer: Healthscope Whirlpool |
$152.37
|
| Rate for Payer: Mclaren Commercial |
$141.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.23
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$227.98 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: BCBS Complete |
$239.40
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$553.56
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Mclaren Medicaid |
$227.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Medicaid |
$239.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$227.98
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.74
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$506.94
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
| Rate for Payer: UHC Medicare Advantage |
$429.28
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: BCBS Trust/PPO |
$553.56
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.62
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$9.85
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: ASR ASR |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$7.12
|
| Rate for Payer: BCN Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.08
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$8.90
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$7.12
|
| Rate for Payer: BCN Commercial |
$7.12
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$8.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$8.26
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.80
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.35
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$6.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.08
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.99
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$10.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
|
|
HC MERCURY
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$16.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.32
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$16.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.26
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Mclaren Medicare |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$15.45
|
| Rate for Payer: PACE SWMI |
$16.26
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Medicaid |
$8.89
|
| Rate for Payer: PHP Medicare Advantage |
$16.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.55
|
| Rate for Payer: Priority Health Medicare |
$16.26
|
| Rate for Payer: Priority Health Narrow Network |
$34.76
|
| Rate for Payer: Railroad Medicare Medicare |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.75
|
| Rate for Payer: VA VA |
$16.26
|
|
|
HC MERCURY
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
|
|
HC MESH
|
Facility
|
IP
|
$4,555.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,188.64 |
| Max. Negotiated Rate |
$4,555.20 |
| Rate for Payer: Aetna Commercial |
$4,099.68
|
| Rate for Payer: ASR ASR |
$4,418.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.65
|
| Rate for Payer: BCN Commercial |
$3,531.65
|
| Rate for Payer: Cash Price |
$3,644.16
|
| Rate for Payer: Cofinity Commercial |
$4,281.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.16
|
| Rate for Payer: Healthscope Commercial |
$4,555.20
|
| Rate for Payer: Healthscope Whirlpool |
$4,418.54
|
| Rate for Payer: Mclaren Commercial |
$4,099.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,871.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,188.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,008.58
|
|
|
HC MESH
|
Facility
|
OP
|
$4,555.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.08 |
| Max. Negotiated Rate |
$4,555.20 |
| Rate for Payer: Aetna Commercial |
$4,099.68
|
| Rate for Payer: ASR ASR |
$4,418.54
|
| Rate for Payer: BCBS Complete |
$1,822.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.65
|
| Rate for Payer: BCN Commercial |
$3,531.65
|
| Rate for Payer: Cash Price |
$3,644.16
|
| Rate for Payer: Cofinity Commercial |
$4,281.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.16
|
| Rate for Payer: Healthscope Commercial |
$4,555.20
|
| Rate for Payer: Healthscope Whirlpool |
$4,418.54
|
| Rate for Payer: Mclaren Commercial |
$4,099.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,871.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,188.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,145.23
|
| Rate for Payer: Priority Health Narrow Network |
$3,234.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,008.58
|
|
|
HC METANEB SUPPLY
|
Facility
|
OP
|
$254.19
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.68 |
| Max. Negotiated Rate |
$254.19 |
| Rate for Payer: Aetna Commercial |
$228.77
|
| Rate for Payer: ASR ASR |
$246.56
|
| Rate for Payer: BCBS Complete |
$101.68
|
| Rate for Payer: BCBS Trust/PPO |
$197.07
|
| Rate for Payer: BCN Commercial |
$197.07
|
| Rate for Payer: Cash Price |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$238.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.35
|
| Rate for Payer: Healthscope Commercial |
$254.19
|
| Rate for Payer: Healthscope Whirlpool |
$246.56
|
| Rate for Payer: Mclaren Commercial |
$228.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.31
|
| Rate for Payer: Priority Health Narrow Network |
$180.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.69
|
|
