|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
OP
|
$325.07
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$130.03 |
| Max. Negotiated Rate |
$325.07 |
| Rate for Payer: Aetna Commercial |
$292.56
|
| Rate for Payer: ASR ASR |
$315.32
|
| Rate for Payer: BCBS Complete |
$130.03
|
| Rate for Payer: BCBS Trust/PPO |
$252.03
|
| Rate for Payer: BCN Commercial |
$252.03
|
| Rate for Payer: Cash Price |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.06
|
| Rate for Payer: Healthscope Commercial |
$325.07
|
| Rate for Payer: Healthscope Whirlpool |
$315.32
|
| Rate for Payer: Mclaren Commercial |
$292.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.81
|
| Rate for Payer: Priority Health Narrow Network |
$230.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.06
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
IP
|
$325.07
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$227.55 |
| Max. Negotiated Rate |
$325.07 |
| Rate for Payer: Aetna Commercial |
$292.56
|
| Rate for Payer: ASR ASR |
$315.32
|
| Rate for Payer: BCBS Trust/PPO |
$252.03
|
| Rate for Payer: BCN Commercial |
$252.03
|
| Rate for Payer: Cash Price |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.06
|
| Rate for Payer: Healthscope Commercial |
$325.07
|
| Rate for Payer: Healthscope Whirlpool |
$315.32
|
| Rate for Payer: Mclaren Commercial |
$292.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.06
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
IP
|
$100.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$70.12 |
| Max. Negotiated Rate |
$100.17 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: ASR ASR |
$97.16
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$77.66
|
| Rate for Payer: Cash Price |
$80.14
|
| Rate for Payer: Cofinity Commercial |
$94.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.14
|
| Rate for Payer: Healthscope Commercial |
$100.17
|
| Rate for Payer: Healthscope Whirlpool |
$97.16
|
| Rate for Payer: Mclaren Commercial |
$90.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.15
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
OP
|
$100.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$100.17 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: ASR ASR |
$97.16
|
| Rate for Payer: BCBS Complete |
$40.07
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$77.66
|
| Rate for Payer: Cash Price |
$80.14
|
| Rate for Payer: Cofinity Commercial |
$94.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.14
|
| Rate for Payer: Healthscope Commercial |
$100.17
|
| Rate for Payer: Healthscope Whirlpool |
$97.16
|
| Rate for Payer: Mclaren Commercial |
$90.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.15
|
| Rate for Payer: Priority Health Narrow Network |
$71.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.15
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
OP
|
$202.38
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$80.95 |
| Max. Negotiated Rate |
$202.38 |
| Rate for Payer: Aetna Commercial |
$182.14
|
| Rate for Payer: ASR ASR |
$196.31
|
| Rate for Payer: BCBS Complete |
$80.95
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$156.91
|
| Rate for Payer: Cash Price |
$161.90
|
| Rate for Payer: Cofinity Commercial |
$190.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.90
|
| Rate for Payer: Healthscope Commercial |
$202.38
|
| Rate for Payer: Healthscope Whirlpool |
$196.31
|
| Rate for Payer: Mclaren Commercial |
$182.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.17
|
| Rate for Payer: Priority Health Narrow Network |
$143.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.09
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
IP
|
$202.38
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$202.38 |
| Rate for Payer: Aetna Commercial |
$182.14
|
| Rate for Payer: ASR ASR |
$196.31
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$156.91
|
| Rate for Payer: Cash Price |
$161.90
|
| Rate for Payer: Cofinity Commercial |
$190.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.90
|
| Rate for Payer: Healthscope Commercial |
$202.38
|
| Rate for Payer: Healthscope Whirlpool |
$196.31
|
| Rate for Payer: Mclaren Commercial |
$182.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.09
|
|
|
HC RED CEDAR IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
OP
|
$286.73
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$536.48 |
| Rate for Payer: Aetna Commercial |
$258.06
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: ASR ASR |
$278.13
|
| Rate for Payer: BCBS Complete |
$106.38
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$222.30
|
| Rate for Payer: BCN Commercial |
$222.30
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cofinity Commercial |
$269.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$286.73
|
| Rate for Payer: Healthscope Whirlpool |
$278.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$185.20
|
| Rate for Payer: Mclaren Commercial |
$258.06
|
| Rate for Payer: Mclaren Medicaid |
$101.30
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Medicaid |
$106.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.72
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$203.72
|
| Rate for Payer: PHP Medicaid |
$101.30
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.48
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health Narrow Network |
$429.18
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.32
|
| Rate for Payer: UHC Medicare Advantage |
$190.76
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$286.73
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$200.71 |
| Max. Negotiated Rate |
$286.73 |
| Rate for Payer: Aetna Commercial |
$258.06
|
| Rate for Payer: ASR ASR |
$278.13
|
| Rate for Payer: BCBS Trust/PPO |
$222.30
|
| Rate for Payer: BCN Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cofinity Commercial |
$269.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.38
|
| Rate for Payer: Healthscope Commercial |
$286.73
|
| Rate for Payer: Healthscope Whirlpool |
$278.13
|
| Rate for Payer: Mclaren Commercial |
$258.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.32
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$204.69 |
| Rate for Payer: Aetna Commercial |
$184.22
|
| Rate for Payer: ASR ASR |
$198.55
|
| Rate for Payer: BCBS Complete |
$81.88
|
| Rate for Payer: BCBS Trust/PPO |
$158.70
|
| Rate for Payer: BCN Commercial |
$158.70
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$192.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.75
|
| Rate for Payer: Healthscope Commercial |
$204.69
|
| Rate for Payer: Healthscope Whirlpool |
$198.55
|
| Rate for Payer: Mclaren Commercial |
$184.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.27
|
| Rate for Payer: Priority Health Narrow Network |
$145.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.13
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$143.28 |
| Max. Negotiated Rate |
$204.69 |
| Rate for Payer: Aetna Commercial |
$184.22
|
| Rate for Payer: ASR ASR |
$198.55
|
| Rate for Payer: BCBS Trust/PPO |
$158.70
|
| Rate for Payer: BCN Commercial |
$158.70
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$192.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.75
|
| Rate for Payer: Healthscope Commercial |
$204.69
|
| Rate for Payer: Healthscope Whirlpool |
$198.55
|
| Rate for Payer: Mclaren Commercial |
$184.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.13
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,084.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$1,084.60 |
| Rate for Payer: Aetna Commercial |
$976.14
|
| Rate for Payer: Aetna Medicare |
$168.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.86
|
| Rate for Payer: ASR ASR |
$1,052.06
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS MAPPO |
$168.69
|
| Rate for Payer: BCBS Trust/PPO |
$840.89
|
| Rate for Payer: BCN Commercial |
$840.89
|
| Rate for Payer: BCN Medicare Advantage |
$168.69
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cofinity Commercial |
$1,019.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.69
|
| Rate for Payer: Healthscope Commercial |
$1,084.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$168.69
|
| Rate for Payer: Mclaren Commercial |
$976.14
|
| Rate for Payer: Mclaren Medicaid |
$92.27
|
| Rate for Payer: Mclaren Medicare |
$168.69
|
| Rate for Payer: Meridian Medicaid |
$96.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$921.91
|
| Rate for Payer: PACE Medicare |
$160.26
|
| Rate for Payer: PACE SWMI |
$168.69
|
| Rate for Payer: PHP Commercial |
$185.56
|
| Rate for Payer: PHP Medicaid |
$92.27
|
| Rate for Payer: PHP Medicare Advantage |
$168.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$168.69
|
| Rate for Payer: Priority Health Narrow Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$168.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$954.45
|
| Rate for Payer: UHC Medicare Advantage |
$173.75
|
| Rate for Payer: VA VA |
$168.69
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,084.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$759.22 |
| Max. Negotiated Rate |
$1,084.60 |
| Rate for Payer: Aetna Commercial |
$976.14
|
| Rate for Payer: ASR ASR |
$1,052.06
|
| Rate for Payer: BCBS Trust/PPO |
$840.89
|
| Rate for Payer: BCN Commercial |
$840.89
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cofinity Commercial |
$1,019.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.68
|
| Rate for Payer: Healthscope Commercial |
$1,084.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.06
|
| Rate for Payer: Mclaren Commercial |
$976.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$921.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$954.45
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.98
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$8.73
|
| Rate for Payer: Mclaren Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.92
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$8.73
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.98
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$8.73
|
| Rate for Payer: Mclaren Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$6.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.92
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$350.20
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Aetna Commercial |
$315.18
|
| Rate for Payer: Aetna Commercial |
$387.04
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$417.15
|
| Rate for Payer: ASR ASR |
$339.69
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$333.42
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: BCN Commercial |
$333.42
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$329.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$350.20
|
| Rate for Payer: Healthscope Commercial |
$430.05
|
| Rate for Payer: Healthscope Whirlpool |
$417.15
|
| Rate for Payer: Healthscope Whirlpool |
$339.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$387.04
|
| Rate for Payer: Mclaren Commercial |
$315.18
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.18
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$350.20
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$245.14 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Aetna Commercial |
$315.18
|
| Rate for Payer: Aetna Commercial |
$387.04
|
| Rate for Payer: ASR ASR |
$339.69
|
| Rate for Payer: ASR ASR |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCBS Trust/PPO |
$333.42
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: BCN Commercial |
$333.42
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$329.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Healthscope Commercial |
$430.05
|
| Rate for Payer: Healthscope Commercial |
$350.20
|
| Rate for Payer: Healthscope Whirlpool |
$339.69
|
| Rate for Payer: Healthscope Whirlpool |
$417.15
|
| Rate for Payer: Mclaren Commercial |
$315.18
|
| Rate for Payer: Mclaren Commercial |
$387.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$864.70
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$605.29 |
| Max. Negotiated Rate |
$864.70 |
| Rate for Payer: Aetna Commercial |
$778.23
|
| Rate for Payer: Aetna Commercial |
$315.18
|
| Rate for Payer: ASR ASR |
$838.76
|
| Rate for Payer: ASR ASR |
$339.69
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCBS Trust/PPO |
$670.40
|
| Rate for Payer: BCN Commercial |
$670.40
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$812.82
|
| Rate for Payer: Cofinity Commercial |
$329.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.76
|
| Rate for Payer: Healthscope Commercial |
$864.70
|
| Rate for Payer: Healthscope Commercial |
$350.20
|
| Rate for Payer: Healthscope Whirlpool |
$339.69
|
| Rate for Payer: Healthscope Whirlpool |
$838.76
|
| Rate for Payer: Mclaren Commercial |
$778.23
|
| Rate for Payer: Mclaren Commercial |
$315.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$735.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$760.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.18
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$864.70
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$864.70 |
| Rate for Payer: Aetna Commercial |
$778.23
|
| Rate for Payer: Aetna Commercial |
$315.18
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$838.76
|
| Rate for Payer: ASR ASR |
$339.69
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$670.40
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: BCN Commercial |
$670.40
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$329.19
|
| Rate for Payer: Cofinity Commercial |
$812.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$350.20
|
| Rate for Payer: Healthscope Commercial |
$864.70
|
| Rate for Payer: Healthscope Whirlpool |
$339.69
|
| Rate for Payer: Healthscope Whirlpool |
$838.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$778.23
|
| Rate for Payer: Mclaren Commercial |
$315.18
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$735.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$760.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.18
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$413.30
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$413.30 |
| Rate for Payer: Aetna Commercial |
$371.97
|
| Rate for Payer: Aetna Medicare |
$265.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$331.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$331.88
|
| Rate for Payer: ASR ASR |
$400.90
|
| Rate for Payer: BCBS Complete |
$152.50
|
| Rate for Payer: BCBS MAPPO |
$265.50
|
| Rate for Payer: BCBS Trust/PPO |
$320.43
|
| Rate for Payer: BCN Commercial |
$320.43
|
| Rate for Payer: BCN Medicare Advantage |
$265.50
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cofinity Commercial |
$388.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.50
|
| Rate for Payer: Healthscope Commercial |
$413.30
|
| Rate for Payer: Healthscope Whirlpool |
$400.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$265.50
|
| Rate for Payer: Mclaren Commercial |
$371.97
|
| Rate for Payer: Mclaren Medicaid |
$145.23
|
| Rate for Payer: Mclaren Medicare |
$265.50
|
| Rate for Payer: Meridian Medicaid |
$152.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$278.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$305.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.30
|
| Rate for Payer: PACE Medicare |
$252.22
|
| Rate for Payer: PACE SWMI |
$265.50
|
| Rate for Payer: PHP Commercial |
$292.05
|
| Rate for Payer: PHP Medicaid |
$145.23
|
| Rate for Payer: PHP Medicare Advantage |
$265.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.10
|
| Rate for Payer: Priority Health Medicare |
$265.50
|
| Rate for Payer: Priority Health Narrow Network |
$293.44
|
| Rate for Payer: Railroad Medicare Medicare |
$265.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.70
|
| Rate for Payer: UHC Medicare Advantage |
$273.46
|
| Rate for Payer: VA VA |
$265.50
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$413.30
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.31 |
| Max. Negotiated Rate |
$413.30 |
| Rate for Payer: Aetna Commercial |
$371.97
|
| Rate for Payer: ASR ASR |
$400.90
|
| Rate for Payer: BCBS Trust/PPO |
$320.43
|
| Rate for Payer: BCN Commercial |
$320.43
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cofinity Commercial |
$388.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.64
|
| Rate for Payer: Healthscope Commercial |
$413.30
|
| Rate for Payer: Healthscope Whirlpool |
$400.90
|
| Rate for Payer: Mclaren Commercial |
$371.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.70
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.39 |
| Max. Negotiated Rate |
$151.98 |
| Rate for Payer: Aetna Commercial |
$136.78
|
| Rate for Payer: ASR ASR |
$147.42
|
| Rate for Payer: BCBS Trust/PPO |
$117.83
|
| Rate for Payer: BCN Commercial |
$117.83
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$142.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Healthscope Commercial |
$151.98
|
| Rate for Payer: Healthscope Whirlpool |
$147.42
|
| Rate for Payer: Mclaren Commercial |
$136.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.74
|
|
