|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$11.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: ASR ASR |
$10.99
|
| Rate for Payer: BCBS Trust/PPO |
$9.30
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$10.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.99
|
| Rate for Payer: Healthscope Whirlpool |
$11.33
|
| Rate for Payer: Mclaren Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$9.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.97
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$11.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$4.19
|
| Rate for Payer: ASR ASR |
$10.99
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$10.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.99
|
| Rate for Payer: Healthscope Whirlpool |
$11.33
|
| Rate for Payer: Mclaren Commercial |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$9.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.93
|
| Rate for Payer: Priority Health Narrow Network |
$7.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.97
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$217.13
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$217.13 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$210.62
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$179.02
|
| Rate for Payer: BCN Commercial |
$179.02
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Commercial |
$204.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$210.62
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$195.42
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Nomi Health Commercial |
$178.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.25
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$152.21
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$217.13
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$217.13 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: ASR ASR |
$210.62
|
| Rate for Payer: BCBS Trust/PPO |
$178.31
|
| Rate for Payer: BCN Commercial |
$178.31
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Commercial |
$204.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$210.62
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Mclaren Commercial |
$195.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Nomi Health Commercial |
$178.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.07
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$78.97 |
| Rate for Payer: Aetna Commercial |
$71.07
|
| Rate for Payer: ASR ASR |
$76.60
|
| Rate for Payer: BCBS Trust/PPO |
$64.85
|
| Rate for Payer: BCN Commercial |
$64.85
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$74.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$76.60
|
| Rate for Payer: Healthscope Whirlpool |
$78.97
|
| Rate for Payer: Mclaren Commercial |
$71.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.49
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$78.97 |
| Rate for Payer: Aetna Commercial |
$71.07
|
| 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 |
$76.60
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$65.11
|
| Rate for Payer: BCN Commercial |
$65.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$74.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$76.60
|
| Rate for Payer: Healthscope Whirlpool |
$78.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$71.07
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| 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 |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| 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 |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.19
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$55.36
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KARIUS SPECTRUM, PLASMA
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,112.00 |
| Max. Negotiated Rate |
$3,295.61 |
| Rate for Payer: Aetna Commercial |
$2,002.50
|
| Rate for Payer: Aetna Medicare |
$2,126.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,657.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,657.75
|
| Rate for Payer: ASR ASR |
$2,158.25
|
| Rate for Payer: BCBS Complete |
$1,167.71
|
| Rate for Payer: BCBS MAPPO |
$2,126.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.51
|
| Rate for Payer: BCN Commercial |
$1,834.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,126.20
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,091.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,126.20
|
| Rate for Payer: Healthscope Commercial |
$2,158.25
|
| Rate for Payer: Healthscope Whirlpool |
$2,225.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,126.20
|
| Rate for Payer: Mclaren Commercial |
$2,002.50
|
| Rate for Payer: Mclaren Medicaid |
$2,126.20
|
| Rate for Payer: Mclaren Medicare |
$2,126.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,232.51
|
| Rate for Payer: Meridian Medicaid |
$1,167.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,445.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,338.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.25
|
| Rate for Payer: Nomi Health Commercial |
$1,824.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.75
|
| Rate for Payer: PACE Medicare |
$2,019.89
|
| Rate for Payer: PACE SWMI |
$2,126.20
|
| Rate for Payer: PHP Commercial |
$2,338.82
|
| Rate for Payer: PHP Medicaid |
$1,139.64
|
| Rate for Payer: PHP Medicare Advantage |
$2,126.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,949.55
|
| Rate for Payer: Priority Health Medicare |
$2,126.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,559.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,126.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,958.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,126.20
|
| Rate for Payer: UHC Exchange |
$3,295.61
|
| Rate for Payer: UHC Medicaid |
$1,112.00
|
| Rate for Payer: UHCCP DNSP |
$2,126.20
|
| Rate for Payer: UHCCP Medicaid |
$1,112.00
|
| Rate for Payer: VA VA |
$2,126.20
|
|
|
HC KARIUS SPECTRUM, PLASMA
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$2,002.50
|
| Rate for Payer: ASR ASR |
$2,158.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.17
|
| Rate for Payer: BCN Commercial |
$1,827.17
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,091.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.00
|
| Rate for Payer: Healthscope Commercial |
$2,158.25
|
| Rate for Payer: Healthscope Whirlpool |
$2,225.00
|
| Rate for Payer: Mclaren Commercial |
$2,002.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.25
|
| Rate for Payer: Nomi Health Commercial |
$1,824.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,958.00
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KERECIS OMEGA3 MARIGEN 3X3.5, PER SQ CM
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.55 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Trust/PPO |
$149.52
|
| Rate for Payer: BCN Commercial |
$149.52
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
|
|
HC KERECIS OMEGA3 MARIGEN 3X3.5, PER SQ CM
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$150.12
|
| Rate for Payer: BCN Commercial |
$150.12
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.32
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$141.06
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC KERECIS OMEGA3 MARIGEN CIRC 16 MM, PER SQ CM
|
Facility
|
IP
|
$687.50
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600275
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$515.62 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$618.75
|
| Rate for Payer: ASR ASR |
$666.88
|
| Rate for Payer: BCBS Trust/PPO |
$564.58
|
| Rate for Payer: BCN Commercial |
$564.58
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cofinity Commercial |
$646.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.00
|
| Rate for Payer: Healthscope Commercial |
$666.88
|
| Rate for Payer: Healthscope Whirlpool |
$687.50
|
| Rate for Payer: Mclaren Commercial |
$618.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.38
|
| Rate for Payer: Nomi Health Commercial |
$563.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.00
|
|
|
HC KERECIS OMEGA3 MARIGEN CIRC 16 MM, PER SQ CM
|
Facility
|
OP
|
$687.50
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600275
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$618.75
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$666.88
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$566.84
|
| Rate for Payer: BCN Commercial |
$566.84
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cofinity Commercial |
$646.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$666.88
|
| Rate for Payer: Healthscope Whirlpool |
$687.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$618.75
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.38
|
| Rate for Payer: Nomi Health Commercial |
$563.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.62
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.32
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$141.06
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC KERECIS OMEGA3 MARIGEN EXPANSE 2X2, PER SQ CM
|
Facility
|
OP
|
$626.88
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$626.88 |
| Rate for Payer: Aetna Commercial |
$564.19
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$608.07
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$516.86
|
| Rate for Payer: BCN Commercial |
$516.86
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$589.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$608.07
|
| Rate for Payer: Healthscope Whirlpool |
$626.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$564.19
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.85
|
| Rate for Payer: Nomi Health Commercial |
$514.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.16
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.32
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$141.06
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC KERECIS OMEGA3 MARIGEN EXPANSE 2X2, PER SQ CM
|
Facility
|
IP
|
$626.88
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$470.16 |
| Max. Negotiated Rate |
$626.88 |
| Rate for Payer: Aetna Commercial |
$564.19
|
| Rate for Payer: ASR ASR |
$608.07
|
| Rate for Payer: BCBS Trust/PPO |
$514.79
|
| Rate for Payer: BCN Commercial |
$514.79
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$589.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.50
|
| Rate for Payer: Healthscope Commercial |
$608.07
|
| Rate for Payer: Healthscope Whirlpool |
$626.88
|
| Rate for Payer: Mclaren Commercial |
$564.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.85
|
| Rate for Payer: Nomi Health Commercial |
$514.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.65
|
|
|
HC KERECIS OMEGA3 MARIGEN MICRO 4 SQ CM, PER SQ CM
|
Facility
|
IP
|
$365.06
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$273.80 |
| Max. Negotiated Rate |
$365.06 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: ASR ASR |
$354.11
|
| Rate for Payer: BCBS Trust/PPO |
$299.79
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cofinity Commercial |
$343.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.05
|
| Rate for Payer: Healthscope Commercial |
$354.11
|
| Rate for Payer: Healthscope Whirlpool |
$365.06
|
| Rate for Payer: Mclaren Commercial |
$328.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.30
|
| Rate for Payer: Nomi Health Commercial |
$299.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.25
|
|
|
HC KERECIS OMEGA3 MARIGEN MICRO 4 SQ CM, PER SQ CM
|
Facility
|
OP
|
$365.06
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$365.06 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$354.11
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$300.99
|
| Rate for Payer: BCN Commercial |
$300.99
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cofinity Commercial |
$343.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$354.11
|
| Rate for Payer: Healthscope Whirlpool |
$365.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$328.55
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.30
|
| Rate for Payer: Nomi Health Commercial |
$299.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.80
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.32
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$141.06
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: ASR ASR |
$36.43
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$30.97
|
| Rate for Payer: BCN Commercial |
$30.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$36.43
|
| Rate for Payer: Healthscope Whirlpool |
$37.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.52
|
| Rate for Payer: Mclaren Commercial |
$33.80
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.17
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$4.97
|
| Rate for Payer: PHP Medicaid |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.91
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$26.33
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.52
|
| Rate for Payer: UHC Exchange |
$7.01
|
| Rate for Payer: UHC Medicaid |
$2.36
|
| Rate for Payer: UHCCP DNSP |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: ASR ASR |
$36.43
|
| Rate for Payer: BCBS Trust/PPO |
$30.84
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$36.43
|
| Rate for Payer: Healthscope Whirlpool |
$37.56
|
| Rate for Payer: Mclaren Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.05
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$6,089.22
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,566.91 |
| Max. Negotiated Rate |
$6,089.22 |
| Rate for Payer: Aetna Commercial |
$5,480.30
|
| Rate for Payer: ASR ASR |
$5,906.54
|
| Rate for Payer: BCBS Trust/PPO |
$5,000.47
|
| Rate for Payer: BCN Commercial |
$5,000.47
|
| Rate for Payer: Cash Price |
$4,871.38
|
| Rate for Payer: Cofinity Commercial |
$5,723.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,871.38
|
| Rate for Payer: Healthscope Commercial |
$5,906.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,089.22
|
| Rate for Payer: Mclaren Commercial |
$5,480.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,175.84
|
| Rate for Payer: Nomi Health Commercial |
$4,993.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,566.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,358.51
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$6,089.22
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$8,280.91 |
| Rate for Payer: Aetna Commercial |
$5,480.30
|
| Rate for Payer: Aetna Medicare |
$5,342.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: ASR ASR |
$5,906.54
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$5,020.56
|
| Rate for Payer: BCN Commercial |
$5,020.56
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$4,871.38
|
| Rate for Payer: Cash Price |
$4,871.38
|
| Rate for Payer: Cofinity Commercial |
$5,723.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,871.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$5,906.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,089.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,342.52
|
| Rate for Payer: Mclaren Commercial |
$5,480.30
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$2,934.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,175.84
|
| Rate for Payer: Nomi Health Commercial |
$4,993.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,566.91
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,876.77
|
| Rate for Payer: PHP Medicaid |
$2,863.59
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,335.37
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Narrow Network |
$4,268.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,358.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$8,280.91
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP DNSP |
$5,342.52
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$141.20
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.90 |
| Max. Negotiated Rate |
$141.20 |
| Rate for Payer: Aetna Commercial |
$127.08
|
| Rate for Payer: ASR ASR |
$136.96
|
| Rate for Payer: BCBS Trust/PPO |
$115.95
|
| Rate for Payer: BCN Commercial |
$115.95
|
| Rate for Payer: Cash Price |
$112.96
|
| Rate for Payer: Cofinity Commercial |
$132.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.96
|
| Rate for Payer: Healthscope Commercial |
$136.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.20
|
| Rate for Payer: Mclaren Commercial |
$127.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.02
|
| Rate for Payer: Nomi Health Commercial |
$115.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.26
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$141.20
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$141.20 |
| Rate for Payer: Aetna Commercial |
$127.08
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: ASR ASR |
$136.96
|
| Rate for Payer: BCBS Complete |
$56.48
|
| Rate for Payer: BCBS Trust/PPO |
$116.42
|
| Rate for Payer: BCN Commercial |
$116.42
|
| Rate for Payer: Cash Price |
$112.96
|
| Rate for Payer: Cash Price |
$112.96
|
| Rate for Payer: Cofinity Commercial |
$132.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.96
|
| Rate for Payer: Healthscope Commercial |
$136.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.20
|
| Rate for Payer: Mclaren Commercial |
$127.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.02
|
| Rate for Payer: Nomi Health Commercial |
$115.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.28
|
| Rate for Payer: Priority Health Narrow Network |
$91.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.26
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$156.06
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
