|
HC MENENCEPH CMPT 4
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$16.85
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.03
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.85
|
| Rate for Payer: UHC Exchange |
$26.12
|
| Rate for Payer: UHC Medicaid |
$8.81
|
| Rate for Payer: UHCCP DNSP |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.64
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.12
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$19.35
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.69
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.64
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$10.12
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$163.42
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.47 |
| Max. Negotiated Rate |
$189.95 |
| Rate for Payer: Aetna Commercial |
$147.08
|
| Rate for Payer: Aetna Medicare |
$60.47
|
| Rate for Payer: ASR ASR |
$158.52
|
| Rate for Payer: BCBS Complete |
$65.37
|
| Rate for Payer: BCBS Trust/PPO |
$134.74
|
| Rate for Payer: BCN Commercial |
$134.74
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$153.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.74
|
| Rate for Payer: Healthscope Commercial |
$158.52
|
| Rate for Payer: Healthscope Whirlpool |
$163.42
|
| Rate for Payer: Mclaren Commercial |
$147.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.91
|
| Rate for Payer: Nomi Health Commercial |
$134.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.81
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$163.42
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.56 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna Commercial |
$147.08
|
| Rate for Payer: ASR ASR |
$158.52
|
| Rate for Payer: BCBS Trust/PPO |
$134.20
|
| Rate for Payer: BCN Commercial |
$134.20
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$153.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.74
|
| Rate for Payer: Healthscope Commercial |
$158.52
|
| Rate for Payer: Healthscope Whirlpool |
$163.42
|
| Rate for Payer: Mclaren Commercial |
$147.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.91
|
| Rate for Payer: Nomi Health Commercial |
$134.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.81
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$746.09
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$217.98 |
| Max. Negotiated Rate |
$746.09 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$723.71
|
| Rate for Payer: BCBS Complete |
$228.90
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$615.15
|
| Rate for Payer: BCN Commercial |
$615.15
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cofinity Commercial |
$701.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$723.71
|
| Rate for Payer: Healthscope Whirlpool |
$746.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$671.48
|
| Rate for Payer: Mclaren Medicaid |
$416.78
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$228.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.18
|
| Rate for Payer: Nomi Health Commercial |
$611.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.57
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$653.72
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$523.01
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicaid |
$217.98
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$217.98
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$746.09
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$559.57 |
| Max. Negotiated Rate |
$746.09 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: ASR ASR |
$723.71
|
| Rate for Payer: BCBS Trust/PPO |
$612.69
|
| Rate for Payer: BCN Commercial |
$612.69
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cofinity Commercial |
$701.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.87
|
| Rate for Payer: Healthscope Commercial |
$723.71
|
| Rate for Payer: Healthscope Whirlpool |
$746.09
|
| Rate for Payer: Mclaren Commercial |
$671.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.18
|
| Rate for Payer: Nomi Health Commercial |
$611.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.56
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$14.00
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$16.85
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.03
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.64
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$10.12
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.85
|
| Rate for Payer: UHC Exchange |
$26.12
|
| Rate for Payer: UHC Medicaid |
$8.81
|
| Rate for Payer: UHCCP DNSP |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: ASR ASR |
$9.26
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Healthscope Whirlpool |
$9.55
|
| Rate for Payer: Mclaren Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.40
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$9.26
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$7.87
|
| Rate for Payer: BCN Commercial |
$7.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Healthscope Whirlpool |
$9.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$8.60
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.37
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$10.42
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC MERCURY
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.83
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
|
|
HC MERCURY
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$16.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.32
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$16.26
|
| Rate for Payer: BCBS Trust/PPO |
$42.00
|
| Rate for Payer: BCN Commercial |
$42.00
|
| Rate for Payer: BCN Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.26
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$16.26
|
| Rate for Payer: Mclaren Medicare |
$16.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.07
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$15.45
|
| Rate for Payer: PACE SWMI |
$16.26
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Medicaid |
$8.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.63
|
| Rate for Payer: Priority Health Medicare |
$16.26
|
| Rate for Payer: Priority Health Narrow Network |
$35.71
|
| Rate for Payer: Railroad Medicare Medicare |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.26
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicaid |
$8.50
|
| Rate for Payer: UHCCP DNSP |
$16.26
|
| Rate for Payer: UHCCP Medicaid |
$8.50
|
| Rate for Payer: VA VA |
$16.26
|
|
|
HC MESH
|
Facility
|
IP
|
$4,739.23
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,554.42 |
| Max. Negotiated Rate |
$4,739.23 |
| Rate for Payer: Aetna Commercial |
$4,265.31
|
| Rate for Payer: ASR ASR |
$4,597.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,891.86
|
| Rate for Payer: BCN Commercial |
$3,891.86
|
| Rate for Payer: Cash Price |
$3,791.38
|
| Rate for Payer: Cofinity Commercial |
$4,454.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,791.38
|
| Rate for Payer: Healthscope Commercial |
$4,597.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,739.23
|
| Rate for Payer: Mclaren Commercial |
$4,265.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,028.35
|
| Rate for Payer: Nomi Health Commercial |
$3,886.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,554.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,170.52
|
|
|
HC MESH
|
Facility
|
OP
|
$4,739.23
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,753.52 |
| Max. Negotiated Rate |
$4,739.23 |
| Rate for Payer: Aetna Commercial |
$4,265.31
|
| Rate for Payer: Aetna Medicare |
$1,753.52
|
| Rate for Payer: ASR ASR |
$4,597.05
|
| Rate for Payer: BCBS Complete |
$1,895.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,907.50
|
| Rate for Payer: BCN Commercial |
$3,907.50
|
| Rate for Payer: Cash Price |
$3,791.38
|
| Rate for Payer: Cofinity Commercial |
$4,454.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,791.38
|
| Rate for Payer: Healthscope Commercial |
$4,597.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,739.23
|
| Rate for Payer: Mclaren Commercial |
$4,265.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,791.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,028.35
|
| Rate for Payer: Nomi Health Commercial |
$3,886.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,554.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,152.51
|
| Rate for Payer: Priority Health Narrow Network |
$3,322.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,170.52
|
|
