|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$338.23 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: ASR ASR |
$328.08
|
| Rate for Payer: ASR Commercial |
$328.08
|
| Rate for Payer: BCBS Trust/PPO |
$275.62
|
| Rate for Payer: BCN Commercial |
$262.23
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$317.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Healthscope Commercial |
$338.23
|
| Rate for Payer: Healthscope Whirlpool |
$328.08
|
| Rate for Payer: Mclaren Commercial |
$304.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.64
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$233.06 |
| Max. Negotiated Rate |
$358.56 |
| Rate for Payer: Aetna Commercial |
$322.70
|
| Rate for Payer: ASR ASR |
$347.80
|
| Rate for Payer: ASR Commercial |
$347.80
|
| Rate for Payer: BCBS Trust/PPO |
$292.19
|
| Rate for Payer: BCN Commercial |
$277.99
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Healthscope Commercial |
$358.56
|
| Rate for Payer: Healthscope Whirlpool |
$347.80
|
| Rate for Payer: Mclaren Commercial |
$322.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.53
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$358.56 |
| Rate for Payer: Aetna Commercial |
$322.70
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$347.80
|
| Rate for Payer: ASR Commercial |
$347.80
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$293.62
|
| Rate for Payer: BCN Commercial |
$277.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$358.56
|
| Rate for Payer: Healthscope Whirlpool |
$347.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$322.70
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.17
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$251.35
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.37
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
IP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,276.28 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$1,767.15
|
| Rate for Payer: ASR ASR |
$1,904.60
|
| Rate for Payer: ASR Commercial |
$1,904.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.06
|
| Rate for Payer: BCN Commercial |
$1,522.30
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,845.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Healthscope Commercial |
$1,963.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.60
|
| Rate for Payer: Mclaren Commercial |
$1,767.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.97
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.88
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$407.11 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$1,767.15
|
| Rate for Payer: Aetna Medicare |
$759.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.41
|
| Rate for Payer: ASR ASR |
$1,904.60
|
| Rate for Payer: ASR Commercial |
$1,904.60
|
| Rate for Payer: BCBS Complete |
$427.46
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,607.91
|
| Rate for Payer: BCN Commercial |
$1,522.30
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,845.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$1,963.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$759.53
|
| Rate for Payer: Mclaren Commercial |
$1,767.15
|
| Rate for Payer: Mclaren Medicaid |
$407.11
|
| Rate for Payer: Mclaren Medicare |
$759.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: Meridian Medicaid |
$427.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.97
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: PACE Medicare |
$721.55
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Commercial |
$835.48
|
| Rate for Payer: PHP Medicaid |
$407.11
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.42
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.41
|
| Rate for Payer: Railroad Medicare Medicare |
$759.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.53
|
| Rate for Payer: UHC Exchange |
$1,177.27
|
| Rate for Payer: UHC Medicare Advantage |
$759.53
|
| Rate for Payer: UHCCP DNSP |
$759.53
|
| Rate for Payer: UHCCP Medicaid |
$407.11
|
| Rate for Payer: VA VA |
$759.53
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR Commercial |
$10.46
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.83
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$10.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$10.78
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$9.70
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: Nomi Health Commercial |
$8.84
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.45
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$7.56
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
IP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR Commercial |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.78
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$10.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$10.78
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Mclaren Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: Nomi Health Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
|
|
HC MDI TREATMENT
|
Facility
|
IP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: ASR ASR |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Trust/PPO |
$121.97
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
|
|
HC MDI TREATMENT
|
Facility
|
OP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$307.46 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: Aetna Medicare |
$198.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCBS Trust/PPO |
$122.56
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$198.36
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicaid |
$106.32
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.14
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health Narrow Network |
$104.92
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$307.46
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP DNSP |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
IP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.21 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: ASR Commercial |
$476.37
|
| Rate for Payer: BCBS Trust/PPO |
$400.20
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: Nomi Health Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
OP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: ASR Commercial |
$476.37
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$402.16
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: Nomi Health Commercial |
$402.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.30
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.67
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$35.74
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
OP
|
$1,568.04
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$2,348.31 |
| Rate for Payer: Aetna Commercial |
$1,411.24
|
| Rate for Payer: Aetna Medicare |
$1,515.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: ASR ASR |
$1,521.00
|
| Rate for Payer: ASR Commercial |
$1,521.00
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.07
|
| Rate for Payer: BCN Commercial |
$1,215.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,473.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$1,568.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,515.04
|
| Rate for Payer: Mclaren Commercial |
$1,411.24
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: Nomi Health Commercial |
$1,285.79
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,666.54
|
| Rate for Payer: PHP Medicaid |
$812.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.92
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP DNSP |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
IP
|
$1,568.04
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,019.23 |
| Max. Negotiated Rate |
$1,568.04 |
| Rate for Payer: Aetna Commercial |
$1,411.24
|
| Rate for Payer: ASR ASR |
$1,521.00
|
| Rate for Payer: ASR Commercial |
$1,521.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.80
|
| Rate for Payer: BCN Commercial |
$1,215.70
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,473.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Healthscope Commercial |
$1,568.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.00
|
| Rate for Payer: Mclaren Commercial |
$1,411.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: Nomi Health Commercial |
$1,285.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.88
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
IP
|
$2,962.57
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,925.67 |
| Max. Negotiated Rate |
$2,962.57 |
| Rate for Payer: Aetna Commercial |
$2,666.31
|
| Rate for Payer: ASR ASR |
$2,873.69
|
| Rate for Payer: ASR Commercial |
$2,873.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,414.20
|
| Rate for Payer: BCN Commercial |
$2,296.88
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cofinity Commercial |
$2,784.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,370.06
|
| Rate for Payer: Healthscope Commercial |
$2,962.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,873.69
|
| Rate for Payer: Mclaren Commercial |
$2,666.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.18
|
| Rate for Payer: Nomi Health Commercial |
$2,429.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,607.06
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
OP
|
$2,962.57
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$2,666.31
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$2,873.69
|
| Rate for Payer: ASR Commercial |
$2,873.69
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,426.05
|
| Rate for Payer: BCN Commercial |
$2,296.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cofinity Commercial |
$2,784.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,370.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,962.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,873.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$2,666.31
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.18
|
| Rate for Payer: Nomi Health Commercial |
$2,429.31
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,595.80
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,076.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,607.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
OP
|
$320.61
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$320.61 |
| Rate for Payer: Aetna Commercial |
$288.55
|
| Rate for Payer: Aetna Medicare |
$198.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$310.99
|
| Rate for Payer: ASR Commercial |
$310.99
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCBS Trust/PPO |
$262.55
|
| Rate for Payer: BCN Commercial |
$248.57
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cofinity Commercial |
$301.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$320.61
|
| Rate for Payer: Healthscope Whirlpool |
$310.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$198.36
|
| Rate for Payer: Mclaren Commercial |
$288.55
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.52
|
| Rate for Payer: Nomi Health Commercial |
$262.90
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicaid |
$106.32
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.92
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health Narrow Network |
$224.75
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$307.46
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP DNSP |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
IP
|
$320.61
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$320.61 |
| Rate for Payer: Aetna Commercial |
$288.55
|
| Rate for Payer: ASR ASR |
$310.99
|
| Rate for Payer: ASR Commercial |
$310.99
|
| Rate for Payer: BCBS Trust/PPO |
$261.27
|
| Rate for Payer: BCN Commercial |
$248.57
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cofinity Commercial |
$301.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.49
|
| Rate for Payer: Healthscope Commercial |
$320.61
|
| Rate for Payer: Healthscope Whirlpool |
$310.99
|
| Rate for Payer: Mclaren Commercial |
$288.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.52
|
| Rate for Payer: Nomi Health Commercial |
$262.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.14
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
OP
|
$1,506.76
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,506.76 |
| Rate for Payer: Aetna Commercial |
$1,356.08
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$1,461.56
|
| Rate for Payer: ASR Commercial |
$1,461.56
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.89
|
| Rate for Payer: BCN Commercial |
$1,168.19
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cofinity Commercial |
$1,416.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,506.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,461.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,356.08
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.75
|
| Rate for Payer: Nomi Health Commercial |
$1,235.54
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,320.22
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,056.24
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
IP
|
$1,506.76
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$979.39 |
| Max. Negotiated Rate |
$1,506.76 |
| Rate for Payer: Aetna Commercial |
$1,356.08
|
| Rate for Payer: ASR ASR |
$1,461.56
|
| Rate for Payer: ASR Commercial |
$1,461.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.86
|
| Rate for Payer: BCN Commercial |
$1,168.19
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cofinity Commercial |
$1,416.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.41
|
| Rate for Payer: Healthscope Commercial |
$1,506.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,461.56
|
| Rate for Payer: Mclaren Commercial |
$1,356.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.75
|
| Rate for Payer: Nomi Health Commercial |
$1,235.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.95
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
OP
|
$1,312.60
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,312.60 |
| Rate for Payer: Aetna Commercial |
$1,181.34
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$1,273.22
|
| Rate for Payer: ASR Commercial |
$1,273.22
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,074.89
|
| Rate for Payer: BCN Commercial |
$1,017.66
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cofinity Commercial |
$1,233.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,312.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,181.34
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,115.71
|
| Rate for Payer: Nomi Health Commercial |
$1,076.33
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.10
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$920.13
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,155.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
IP
|
$1,312.60
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$853.19 |
| Max. Negotiated Rate |
$1,312.60 |
| Rate for Payer: Aetna Commercial |
$1,181.34
|
| Rate for Payer: ASR ASR |
$1,273.22
|
| Rate for Payer: ASR Commercial |
$1,273.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.64
|
| Rate for Payer: BCN Commercial |
$1,017.66
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cofinity Commercial |
$1,233.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.08
|
| Rate for Payer: Healthscope Commercial |
$1,312.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.22
|
| Rate for Payer: Mclaren Commercial |
$1,181.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,115.71
|
| Rate for Payer: Nomi Health Commercial |
$1,076.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,155.09
|
|
