|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$843.51 |
| Rate for Payer: Aetna Commercial |
$759.16
|
| Rate for Payer: Aetna Medicare |
$421.75
|
| Rate for Payer: ASR ASR |
$818.20
|
| Rate for Payer: ASR Commercial |
$818.20
|
| Rate for Payer: BCBS Complete |
$337.40
|
| Rate for Payer: BCBS Trust/PPO |
$690.75
|
| Rate for Payer: BCN Commercial |
$653.97
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$792.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$843.51
|
| Rate for Payer: Healthscope Whirlpool |
$818.20
|
| Rate for Payer: Mclaren Commercial |
$759.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.08
|
| Rate for Payer: Priority Health Narrow Network |
$591.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$742.29
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: ASR ASR |
$217.67
|
| Rate for Payer: ASR Commercial |
$217.67
|
| Rate for Payer: BCBS Trust/PPO |
$182.86
|
| Rate for Payer: BCN Commercial |
$173.98
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$224.40
|
| Rate for Payer: Healthscope Whirlpool |
$217.67
|
| Rate for Payer: Mclaren Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.47
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: ASR ASR |
$217.67
|
| Rate for Payer: ASR Commercial |
$217.67
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS Trust/PPO |
$183.76
|
| Rate for Payer: BCN Commercial |
$173.98
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$224.40
|
| Rate for Payer: Healthscope Whirlpool |
$217.67
|
| Rate for Payer: Mclaren Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.62
|
| Rate for Payer: Priority Health Narrow Network |
$157.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.47
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$929.49 |
| Max. Negotiated Rate |
$1,429.99 |
| Rate for Payer: Aetna Commercial |
$1,286.99
|
| Rate for Payer: ASR ASR |
$1,387.09
|
| Rate for Payer: ASR Commercial |
$1,387.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.30
|
| Rate for Payer: BCN Commercial |
$1,108.67
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Healthscope Commercial |
$1,429.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,387.09
|
| Rate for Payer: Mclaren Commercial |
$1,286.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.39
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,429.99 |
| Rate for Payer: Aetna Commercial |
$1,286.99
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$1,387.09
|
| Rate for Payer: ASR Commercial |
$1,387.09
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.02
|
| Rate for Payer: BCN Commercial |
$1,108.67
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,429.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,387.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$1,286.99
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.96
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,002.42
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$802.09 |
| Rate for Payer: Aetna Commercial |
$445.55
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$480.20
|
| Rate for Payer: ASR Commercial |
$480.20
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$405.40
|
| Rate for Payer: BCN Commercial |
$383.81
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$465.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$495.05
|
| Rate for Payer: Healthscope Whirlpool |
$480.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$445.55
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.76
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$347.03
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$321.78 |
| Max. Negotiated Rate |
$495.05 |
| Rate for Payer: Aetna Commercial |
$445.55
|
| Rate for Payer: ASR ASR |
$480.20
|
| Rate for Payer: ASR Commercial |
$480.20
|
| Rate for Payer: BCBS Trust/PPO |
$403.42
|
| Rate for Payer: BCN Commercial |
$383.81
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$465.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Healthscope Commercial |
$495.05
|
| Rate for Payer: Healthscope Whirlpool |
$480.20
|
| Rate for Payer: Mclaren Commercial |
$445.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.64
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.49
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Complete |
$8.77
|
| Rate for Payer: BCBS MAPPO |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$60.14
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: BCN Medicare Advantage |
$15.59
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.59
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$8.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Medicare |
$14.81
|
| Rate for Payer: PACE SWMI |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.15
|
| Rate for Payer: PHP Medicaid |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$15.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$15.59
|
| Rate for Payer: Priority Health Narrow Network |
$51.48
|
| Rate for Payer: Railroad Medicare Medicare |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.59
|
| Rate for Payer: UHC Exchange |
$24.16
|
| Rate for Payer: UHC Medicare Advantage |
$15.59
|
| Rate for Payer: UHCCP DNSP |
$15.59
|
| Rate for Payer: UHCCP Medicaid |
$8.36
|
| Rate for Payer: VA VA |
$15.59
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.85
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$35.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$180.93 |
| Rate for Payer: Aetna Commercial |
$162.84
|
| Rate for Payer: ASR ASR |
$175.50
|
| Rate for Payer: ASR Commercial |
$175.50
|
| Rate for Payer: BCBS Trust/PPO |
$147.44
|
| Rate for Payer: BCN Commercial |
$140.28
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$170.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Healthscope Commercial |
$180.93
|
| Rate for Payer: Healthscope Whirlpool |
$175.50
|
| Rate for Payer: Mclaren Commercial |
$162.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.22
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$194.80 |
| Rate for Payer: Aetna Commercial |
$162.84
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$175.50
|
| Rate for Payer: ASR Commercial |
$175.50
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$148.16
|
| Rate for Payer: BCN Commercial |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$170.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$180.93
|
| Rate for Payer: Healthscope Whirlpool |
$175.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$162.84
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.53
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$126.83
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$579.68 |
| Rate for Payer: Aetna Commercial |
$521.71
|
| Rate for Payer: Aetna Medicare |
$323.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: ASR ASR |
$562.29
|
| Rate for Payer: ASR Commercial |
$562.29
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCBS Trust/PPO |
$474.70
|
| Rate for Payer: BCN Commercial |
$449.43
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$544.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$579.68
|
| Rate for Payer: Healthscope Whirlpool |
$562.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.49
|
| Rate for Payer: Mclaren Commercial |
$521.71
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: PHP Medicaid |
$173.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.92
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health Narrow Network |
$406.36
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$501.41
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP DNSP |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$579.68 |
| Rate for Payer: Aetna Commercial |
$521.71
|
| Rate for Payer: ASR ASR |
$562.29
|
| Rate for Payer: ASR Commercial |
$562.29
|
| Rate for Payer: BCBS Trust/PPO |
$472.38
|
| Rate for Payer: BCN Commercial |
$449.43
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$544.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Healthscope Commercial |
$579.68
|
| Rate for Payer: Healthscope Whirlpool |
$562.29
|
| Rate for Payer: Mclaren Commercial |
$521.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.12
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Aetna Commercial |
$142.29
|
| Rate for Payer: Aetna Medicare |
$79.05
|
| Rate for Payer: ASR ASR |
$153.36
|
| Rate for Payer: ASR Commercial |
$153.36
|
| Rate for Payer: BCBS Complete |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$129.47
|
| Rate for Payer: BCN Commercial |
$122.57
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$148.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$158.10
|
| Rate for Payer: Healthscope Whirlpool |
$153.36
|
| Rate for Payer: Mclaren Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.53
|
| Rate for Payer: Priority Health Narrow Network |
$110.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.13
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.77 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Aetna Commercial |
$142.29
|
| Rate for Payer: ASR ASR |
$153.36
|
| Rate for Payer: ASR Commercial |
$153.36
|
| Rate for Payer: BCBS Trust/PPO |
$128.84
|
| Rate for Payer: BCN Commercial |
$122.57
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$148.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$158.10
|
| Rate for Payer: Healthscope Whirlpool |
$153.36
|
| Rate for Payer: Mclaren Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.13
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: ASR ASR |
$123.12
|
| Rate for Payer: ASR Commercial |
$123.12
|
| Rate for Payer: BCBS Trust/PPO |
$103.44
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$119.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Healthscope Whirlpool |
$123.12
|
| Rate for Payer: Mclaren Commercial |
$114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.70
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$139.83 |
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: Aetna Medicare |
$90.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.76
|
| Rate for Payer: ASR ASR |
$123.12
|
| Rate for Payer: ASR Commercial |
$123.12
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$90.21
|
| Rate for Payer: BCBS Trust/PPO |
$103.94
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: BCN Medicare Advantage |
$90.21
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$119.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.21
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Healthscope Whirlpool |
$123.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.21
|
| Rate for Payer: Mclaren Commercial |
$114.24
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Mclaren Medicare |
$90.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PACE Medicare |
$85.70
|
| Rate for Payer: PACE SWMI |
$90.21
|
| Rate for Payer: PHP Commercial |
$99.23
|
| Rate for Payer: PHP Medicaid |
$48.35
|
| Rate for Payer: PHP Medicare Advantage |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.22
|
| Rate for Payer: Priority Health Medicare |
$90.21
|
| Rate for Payer: Priority Health Narrow Network |
$88.98
|
| Rate for Payer: Railroad Medicare Medicare |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.21
|
| Rate for Payer: UHC Exchange |
$139.83
|
| Rate for Payer: UHC Medicare Advantage |
$90.21
|
| Rate for Payer: UHCCP DNSP |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
| Rate for Payer: VA VA |
$90.21
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$626.91 |
| Max. Negotiated Rate |
$964.47 |
| Rate for Payer: Aetna Commercial |
$868.02
|
| Rate for Payer: ASR ASR |
$935.54
|
| Rate for Payer: ASR Commercial |
$935.54
|
| Rate for Payer: BCBS Trust/PPO |
$785.95
|
| Rate for Payer: BCN Commercial |
$747.75
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$906.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$964.47
|
| Rate for Payer: Healthscope Whirlpool |
$935.54
|
| Rate for Payer: Mclaren Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.73
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.79 |
| Max. Negotiated Rate |
$964.47 |
| Rate for Payer: Aetna Commercial |
$868.02
|
| Rate for Payer: Aetna Medicare |
$482.24
|
| Rate for Payer: ASR ASR |
$935.54
|
| Rate for Payer: ASR Commercial |
$935.54
|
| Rate for Payer: BCBS Complete |
$385.79
|
| Rate for Payer: BCBS Trust/PPO |
$789.80
|
| Rate for Payer: BCN Commercial |
$747.75
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$906.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$964.47
|
| Rate for Payer: Healthscope Whirlpool |
$935.54
|
| Rate for Payer: Mclaren Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.07
|
| Rate for Payer: Priority Health Narrow Network |
$676.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.73
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$1,345.83 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.72
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.33
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$888.31
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.69 |
| Max. Negotiated Rate |
$1,267.21 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.65
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.89 |
| Max. Negotiated Rate |
$1,855.22 |
| Rate for Payer: Aetna Commercial |
$1,669.70
|
| Rate for Payer: ASR ASR |
$1,799.56
|
| Rate for Payer: ASR Commercial |
$1,799.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.82
|
| Rate for Payer: BCN Commercial |
$1,438.35
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,743.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Healthscope Commercial |
$1,855.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,799.56
|
| Rate for Payer: Mclaren Commercial |
$1,669.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,632.59
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$1,855.22 |
| Rate for Payer: Aetna Commercial |
$1,669.70
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,799.56
|
| Rate for Payer: ASR Commercial |
$1,799.56
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,519.24
|
| Rate for Payer: BCN Commercial |
$1,438.35
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,743.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,855.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,799.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,669.70
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,625.54
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,300.51
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,632.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
