|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$725.42 |
| Max. Negotiated Rate |
$967.23 |
| Rate for Payer: Aetna Commercial |
$870.51
|
| Rate for Payer: ASR ASR |
$938.21
|
| Rate for Payer: BCBS Trust/PPO |
$794.29
|
| Rate for Payer: BCN Commercial |
$794.29
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$938.21
|
| Rate for Payer: Healthscope Whirlpool |
$967.23
|
| Rate for Payer: Mclaren Commercial |
$870.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.16
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,002.35 |
| Rate for Payer: Aetna Commercial |
$870.51
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$938.21
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$797.48
|
| Rate for Payer: BCN Commercial |
$797.48
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$938.21
|
| Rate for Payer: Healthscope Whirlpool |
$967.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$870.51
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,002.35
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$801.88
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.22 |
| Max. Negotiated Rate |
$220.29 |
| Rate for Payer: Aetna Commercial |
$198.26
|
| Rate for Payer: ASR ASR |
$213.68
|
| Rate for Payer: BCBS Trust/PPO |
$180.90
|
| Rate for Payer: BCN Commercial |
$180.90
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Commercial |
$207.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Healthscope Commercial |
$213.68
|
| Rate for Payer: Healthscope Whirlpool |
$220.29
|
| Rate for Payer: Mclaren Commercial |
$198.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$180.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.86
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$198.26
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$213.68
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$181.63
|
| Rate for Payer: BCN Commercial |
$181.63
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Commercial |
$207.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$213.68
|
| Rate for Payer: Healthscope Whirlpool |
$220.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$198.26
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$180.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$565.89
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$609.91
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$518.42
|
| Rate for Payer: BCN Commercial |
$518.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Commercial |
$591.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$609.91
|
| Rate for Payer: Healthscope Whirlpool |
$628.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$565.89
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$515.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$553.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.58 |
| Max. Negotiated Rate |
$628.77 |
| Rate for Payer: Aetna Commercial |
$565.89
|
| Rate for Payer: ASR ASR |
$609.91
|
| Rate for Payer: BCBS Trust/PPO |
$516.35
|
| Rate for Payer: BCN Commercial |
$516.35
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Commercial |
$591.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Healthscope Commercial |
$609.91
|
| Rate for Payer: Healthscope Whirlpool |
$628.77
|
| Rate for Payer: Mclaren Commercial |
$565.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$515.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$553.32
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.66 |
| Max. Negotiated Rate |
$335.55 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: ASR ASR |
$325.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.55
|
| Rate for Payer: BCN Commercial |
$275.55
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$315.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Healthscope Commercial |
$325.48
|
| Rate for Payer: Healthscope Whirlpool |
$335.55
|
| Rate for Payer: Mclaren Commercial |
$302.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$275.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.28
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$325.48
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$276.66
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$315.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$325.48
|
| Rate for Payer: Healthscope Whirlpool |
$335.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$302.00
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$275.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.29 |
| Max. Negotiated Rate |
$315.06 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: BCBS Trust/PPO |
$258.73
|
| Rate for Payer: BCN Commercial |
$258.73
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$305.61
|
| Rate for Payer: Healthscope Whirlpool |
$315.06
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$259.77
|
| Rate for Payer: BCN Commercial |
$259.77
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$305.61
|
| Rate for Payer: Healthscope Whirlpool |
$315.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$273.59
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$294.87
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$250.64
|
| Rate for Payer: BCN Commercial |
$250.64
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Commercial |
$285.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$294.87
|
| Rate for Payer: Healthscope Whirlpool |
$303.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$273.59
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Nomi Health Commercial |
$249.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.99 |
| Max. Negotiated Rate |
$303.99 |
| Rate for Payer: Aetna Commercial |
$273.59
|
| Rate for Payer: ASR ASR |
$294.87
|
| Rate for Payer: BCBS Trust/PPO |
$249.64
|
| Rate for Payer: BCN Commercial |
$249.64
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Commercial |
$285.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Healthscope Commercial |
$294.87
|
| Rate for Payer: Healthscope Whirlpool |
$303.99
|
| Rate for Payer: Mclaren Commercial |
$273.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Nomi Health Commercial |
$249.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.51
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.21 |
| Max. Negotiated Rate |
$236.28 |
| Rate for Payer: Aetna Commercial |
$212.65
|
| Rate for Payer: ASR ASR |
$229.19
|
| Rate for Payer: BCBS Trust/PPO |
$194.03
|
| Rate for Payer: BCN Commercial |
$194.03
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Commercial |
$222.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Healthscope Commercial |
$229.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.28
|
| Rate for Payer: Mclaren Commercial |
$212.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$193.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.93
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$212.65
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$229.19
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$194.81
|
| Rate for Payer: BCN Commercial |
$194.81
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Commercial |
$222.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$229.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$212.65
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$193.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.36 |
| Max. Negotiated Rate |
$165.82 |
| Rate for Payer: Aetna Commercial |
$149.24
|
| Rate for Payer: ASR ASR |
$160.85
|
| Rate for Payer: BCBS Trust/PPO |
$136.17
|
| Rate for Payer: BCN Commercial |
$136.17
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$160.85
|
| Rate for Payer: Healthscope Whirlpool |
$165.82
|
| Rate for Payer: Mclaren Commercial |
$149.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Nomi Health Commercial |
$135.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.92
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$149.24
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$160.85
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$136.72
|
| Rate for Payer: BCN Commercial |
$136.72
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$160.85
|
| Rate for Payer: Healthscope Whirlpool |
$165.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$149.24
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Nomi Health Commercial |
$135.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$132.13
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$142.41
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.04
|
| Rate for Payer: BCN Commercial |
$121.04
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Commercial |
$138.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$142.41
|
| Rate for Payer: Healthscope Whirlpool |
$146.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$132.13
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Nomi Health Commercial |
$120.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,570.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,856.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$146.81 |
| Rate for Payer: Aetna Commercial |
$132.13
|
| Rate for Payer: ASR ASR |
$142.41
|
| Rate for Payer: BCBS Trust/PPO |
$120.56
|
| Rate for Payer: BCN Commercial |
$120.56
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Commercial |
$138.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$142.41
|
| Rate for Payer: Healthscope Whirlpool |
$146.81
|
| Rate for Payer: Mclaren Commercial |
$132.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Nomi Health Commercial |
$120.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.19
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$53.61
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$45.57
|
| Rate for Payer: BCN Commercial |
$45.57
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Commercial |
$51.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$53.61
|
| Rate for Payer: Healthscope Whirlpool |
$55.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$49.74
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Nomi Health Commercial |
$45.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
