|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Trust/PPO |
$88.51
|
| Rate for Payer: BCN Commercial |
$88.51
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,420.34
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,212.05 |
| Max. Negotiated Rate |
$12,420.34 |
| Rate for Payer: Aetna Commercial |
$11,178.31
|
| Rate for Payer: Aetna Medicare |
$2,317.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,896.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,896.88
|
| Rate for Payer: ASR ASR |
$12,047.73
|
| Rate for Payer: BCBS Complete |
$1,272.77
|
| Rate for Payer: BCBS MAPPO |
$2,317.50
|
| Rate for Payer: BCBS Trust/PPO |
$10,240.57
|
| Rate for Payer: BCN Commercial |
$10,240.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,317.50
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cofinity Commercial |
$11,675.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,936.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,317.50
|
| Rate for Payer: Healthscope Commercial |
$12,047.73
|
| Rate for Payer: Healthscope Whirlpool |
$12,420.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,317.50
|
| Rate for Payer: Mclaren Commercial |
$11,178.31
|
| Rate for Payer: Mclaren Medicaid |
$2,317.50
|
| Rate for Payer: Mclaren Medicare |
$2,317.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,433.38
|
| Rate for Payer: Meridian Medicaid |
$1,272.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,665.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,549.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,557.29
|
| Rate for Payer: Nomi Health Commercial |
$10,184.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,315.25
|
| Rate for Payer: PACE Medicare |
$2,201.62
|
| Rate for Payer: PACE SWMI |
$2,317.50
|
| Rate for Payer: PHP Commercial |
$2,549.25
|
| Rate for Payer: PHP Medicaid |
$1,242.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,317.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,212.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,210.58
|
| Rate for Payer: Priority Health Medicare |
$2,317.50
|
| Rate for Payer: Priority Health Narrow Network |
$4,168.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,317.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,929.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,317.50
|
| Rate for Payer: UHC Exchange |
$3,592.12
|
| Rate for Payer: UHC Medicaid |
$1,212.05
|
| Rate for Payer: UHCCP DNSP |
$2,317.50
|
| Rate for Payer: UHCCP Medicaid |
$1,212.05
|
| Rate for Payer: VA VA |
$2,317.50
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,420.34
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$9,315.25 |
| Max. Negotiated Rate |
$12,420.34 |
| Rate for Payer: Aetna Commercial |
$11,178.31
|
| Rate for Payer: ASR ASR |
$12,047.73
|
| Rate for Payer: BCBS Trust/PPO |
$10,199.58
|
| Rate for Payer: BCN Commercial |
$10,199.58
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cofinity Commercial |
$11,675.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,936.27
|
| Rate for Payer: Healthscope Commercial |
$12,047.73
|
| Rate for Payer: Healthscope Whirlpool |
$12,420.34
|
| Rate for Payer: Mclaren Commercial |
$11,178.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,557.29
|
| Rate for Payer: Nomi Health Commercial |
$10,184.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,315.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,929.90
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Trust/PPO |
$210.23
|
| Rate for Payer: BCN Commercial |
$210.23
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$248.32
|
| Rate for Payer: Healthscope Whirlpool |
$256.00
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Medicare |
$94.72
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS Trust/PPO |
$211.07
|
| Rate for Payer: BCN Commercial |
$211.07
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$248.32
|
| Rate for Payer: Healthscope Whirlpool |
$256.00
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$199.47
|
| Rate for Payer: Priority Health Narrow Network |
$159.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$69.49
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$69.49 |
| Rate for Payer: Aetna Commercial |
$62.54
|
| Rate for Payer: ASR ASR |
$67.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.07
|
| Rate for Payer: BCN Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.59
|
| Rate for Payer: Healthscope Commercial |
$67.41
|
| Rate for Payer: Healthscope Whirlpool |
$69.49
|
| Rate for Payer: Mclaren Commercial |
$62.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.07
|
| Rate for Payer: Nomi Health Commercial |
$56.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.15
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$69.49
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Aetna Commercial |
$62.54
|
| Rate for Payer: Aetna Medicare |
$24.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.09
|
| Rate for Payer: ASR ASR |
$67.41
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS MAPPO |
$24.07
|
| Rate for Payer: BCBS Trust/PPO |
$57.29
|
| Rate for Payer: BCN Commercial |
$57.29
|
| Rate for Payer: BCN Medicare Advantage |
$24.07
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.07
|
| Rate for Payer: Healthscope Commercial |
$67.41
|
| Rate for Payer: Healthscope Whirlpool |
$69.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.07
|
| Rate for Payer: Mclaren Commercial |
$62.54
|
| Rate for Payer: Mclaren Medicaid |
$24.07
|
| Rate for Payer: Mclaren Medicare |
$24.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.27
|
| Rate for Payer: Meridian Medicaid |
$13.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.07
|
| Rate for Payer: Nomi Health Commercial |
$56.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.12
|
| Rate for Payer: PACE Medicare |
$22.87
|
| Rate for Payer: PACE SWMI |
$24.07
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Medicaid |
$12.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.62
|
| Rate for Payer: Priority Health Medicare |
$24.07
|
| Rate for Payer: Priority Health Narrow Network |
$76.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.07
|
| Rate for Payer: UHC Exchange |
$37.31
|
| Rate for Payer: UHC Medicaid |
$12.59
|
| Rate for Payer: UHCCP DNSP |
$24.07
|
| Rate for Payer: UHCCP Medicaid |
$12.59
|
| Rate for Payer: VA VA |
$24.07
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: ASR ASR |
$47.36
|
| Rate for Payer: BCBS Trust/PPO |
$40.09
|
| Rate for Payer: BCN Commercial |
$40.09
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.36
|
| Rate for Payer: Healthscope Whirlpool |
$48.82
|
| Rate for Payer: Mclaren Commercial |
$43.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.96
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$48.82
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: ASR ASR |
$47.36
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$40.25
|
| Rate for Payer: BCN Commercial |
$40.25
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.36
|
| Rate for Payer: Healthscope Whirlpool |
$48.82
|
| Rate for Payer: Mclaren Commercial |
$43.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.60
|
| Rate for Payer: Priority Health Narrow Network |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.96
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: ASR ASR |
$47.37
|
| Rate for Payer: BCBS Trust/PPO |
$40.10
|
| Rate for Payer: BCN Commercial |
$40.10
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Healthscope Whirlpool |
$48.83
|
| Rate for Payer: Mclaren Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$18.07
|
| Rate for Payer: ASR ASR |
$47.37
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$40.26
|
| Rate for Payer: BCN Commercial |
$40.26
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Healthscope Whirlpool |
$48.83
|
| Rate for Payer: Mclaren Commercial |
$43.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.49
|
| Rate for Payer: Priority Health Narrow Network |
$5.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.96
|
| Rate for Payer: ASR ASR |
$47.37
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: BCBS MAPPO |
$20.77
|
| Rate for Payer: BCBS Trust/PPO |
$40.26
|
| Rate for Payer: BCN Commercial |
$40.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.77
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.77
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Healthscope Whirlpool |
$48.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.77
|
| Rate for Payer: Mclaren Commercial |
$43.95
|
| Rate for Payer: Mclaren Medicaid |
$20.77
|
| Rate for Payer: Mclaren Medicare |
$20.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.81
|
| Rate for Payer: Meridian Medicaid |
$11.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PACE Medicare |
$19.73
|
| Rate for Payer: PACE SWMI |
$20.77
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: PHP Medicaid |
$11.13
|
| Rate for Payer: PHP Medicare Advantage |
$20.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.78
|
| Rate for Payer: Priority Health Medicare |
$20.77
|
| Rate for Payer: Priority Health Narrow Network |
$34.23
|
| Rate for Payer: Railroad Medicare Medicare |
$20.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.77
|
| Rate for Payer: UHC Exchange |
$32.19
|
| Rate for Payer: UHC Medicaid |
$10.86
|
| Rate for Payer: UHCCP DNSP |
$20.77
|
| Rate for Payer: UHCCP Medicaid |
$10.86
|
| Rate for Payer: VA VA |
$20.77
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: ASR ASR |
$47.37
|
| Rate for Payer: BCBS Trust/PPO |
$40.10
|
| Rate for Payer: BCN Commercial |
$40.10
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Healthscope Whirlpool |
$48.83
|
| Rate for Payer: Mclaren Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Nomi Health Commercial |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.97
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.33 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.95
|
| Rate for Payer: BCN Commercial |
$87.95
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$103.89
|
| Rate for Payer: Healthscope Whirlpool |
$107.10
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$88.30
|
| Rate for Payer: BCN Commercial |
$88.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$103.89
|
| Rate for Payer: Healthscope Whirlpool |
$107.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$11.98
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.84
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$75.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: Aetna Medicare |
$154.23
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: BCBS Trust/PPO |
$343.68
|
| Rate for Payer: BCN Commercial |
$343.68
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$404.33
|
| Rate for Payer: Healthscope Whirlpool |
$416.84
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$365.24
|
| Rate for Payer: Priority Health Narrow Network |
$292.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.63 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: BCBS Trust/PPO |
$342.31
|
| Rate for Payer: BCN Commercial |
$342.31
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$404.33
|
| Rate for Payer: Healthscope Whirlpool |
$416.84
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$406.41
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$304.81 |
| Max. Negotiated Rate |
$406.41 |
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: ASR ASR |
$394.22
|
| Rate for Payer: BCBS Trust/PPO |
$333.74
|
| Rate for Payer: BCN Commercial |
$333.74
|
| Rate for Payer: Cash Price |
$325.13
|
| Rate for Payer: Cofinity Commercial |
$382.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.13
|
| Rate for Payer: Healthscope Commercial |
$394.22
|
| Rate for Payer: Healthscope Whirlpool |
$406.41
|
| Rate for Payer: Mclaren Commercial |
$365.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.45
|
| Rate for Payer: Nomi Health Commercial |
$333.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.64
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$406.41
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$510.14 |
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$394.22
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$335.09
|
| Rate for Payer: BCN Commercial |
$335.09
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$325.13
|
| Rate for Payer: Cash Price |
$325.13
|
| Rate for Payer: Cofinity Commercial |
$382.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$394.22
|
| Rate for Payer: Healthscope Whirlpool |
$406.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$365.77
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.45
|
| Rate for Payer: Nomi Health Commercial |
$333.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.81
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$356.10
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$284.89
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
IP
|
$59.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.48 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.70
|
| Rate for Payer: BCN Commercial |
$48.70
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$57.52
|
| Rate for Payer: Healthscope Whirlpool |
$59.30
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
OP
|
$59.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$48.89
|
| Rate for Payer: BCN Commercial |
$48.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$57.52
|
| Rate for Payer: Healthscope Whirlpool |
$59.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.25
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: Mclaren Medicaid |
$12.25
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: Meridian Medicaid |
$6.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.47
|
| Rate for Payer: PHP Medicaid |
$6.57
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.96
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health Narrow Network |
$41.57
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.25
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicaid |
$6.41
|
| Rate for Payer: UHCCP DNSP |
$12.25
|
| Rate for Payer: UHCCP Medicaid |
$6.41
|
| Rate for Payer: VA VA |
$12.25
|
|
