|
HC NEG PRES WOUND TX SET MED
|
Facility
|
OP
|
$79.99
|
|
| Hospital Charge Code |
27200127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Aetna Commercial |
$71.99
|
| Rate for Payer: Aetna Medicare |
$39.99
|
| Rate for Payer: ASR ASR |
$77.59
|
| Rate for Payer: ASR Commercial |
$77.59
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$65.50
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.99
|
| Rate for Payer: Healthscope Commercial |
$79.99
|
| Rate for Payer: Healthscope Whirlpool |
$77.59
|
| Rate for Payer: Mclaren Commercial |
$71.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.99
|
| Rate for Payer: Nomi Health Commercial |
$65.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.09
|
| Rate for Payer: Priority Health Narrow Network |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.39
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
OP
|
$115.99
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: Aetna Medicare |
$57.99
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS Trust/PPO |
$94.98
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.63
|
| Rate for Payer: Priority Health Narrow Network |
$81.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
IP
|
$115.99
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Trust/PPO |
$94.52
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
OP
|
$7.86
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: ASR ASR |
$7.62
|
| Rate for Payer: ASR Commercial |
$7.62
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$7.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.86
|
| Rate for Payer: Healthscope Whirlpool |
$7.62
|
| Rate for Payer: Mclaren Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.89
|
| Rate for Payer: Priority Health Narrow Network |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.92
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
IP
|
$7.86
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: ASR ASR |
$7.62
|
| Rate for Payer: ASR Commercial |
$7.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$7.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.86
|
| Rate for Payer: Healthscope Whirlpool |
$7.62
|
| Rate for Payer: Mclaren Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.92
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| 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 |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$55.38
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| 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 |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| 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 |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| 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 NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.11
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| 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 |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| 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 NEONATAL VENT INIT DAY
|
Facility
|
OP
|
$1,569.06
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,569.06 |
| Rate for Payer: Aetna Commercial |
$1,412.15
|
| 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 |
$1,521.99
|
| Rate for Payer: ASR Commercial |
$1,521.99
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.90
|
| Rate for Payer: BCN Commercial |
$1,216.49
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cofinity Commercial |
$1,474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,569.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,412.15
|
| 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 |
$1,333.70
|
| Rate for Payer: Nomi Health Commercial |
$1,286.63
|
| 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 |
$1,019.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,374.81
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.91
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.77
|
| 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 NEONATAL VENT INIT DAY
|
Facility
|
IP
|
$1,569.06
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,019.89 |
| Max. Negotiated Rate |
$1,569.06 |
| Rate for Payer: Aetna Commercial |
$1,412.15
|
| Rate for Payer: ASR ASR |
$1,521.99
|
| Rate for Payer: ASR Commercial |
$1,521.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.63
|
| Rate for Payer: BCN Commercial |
$1,216.49
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cofinity Commercial |
$1,474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.25
|
| Rate for Payer: Healthscope Commercial |
$1,569.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.99
|
| Rate for Payer: Mclaren Commercial |
$1,412.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.70
|
| Rate for Payer: Nomi Health Commercial |
$1,286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.77
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
IP
|
$1,197.45
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$778.34 |
| Max. Negotiated Rate |
$1,197.45 |
| Rate for Payer: Aetna Commercial |
$1,077.70
|
| Rate for Payer: ASR ASR |
$1,161.53
|
| Rate for Payer: ASR Commercial |
$1,161.53
|
| Rate for Payer: BCBS Trust/PPO |
$975.80
|
| Rate for Payer: BCN Commercial |
$928.38
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cofinity Commercial |
$1,125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.96
|
| Rate for Payer: Healthscope Commercial |
$1,197.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.53
|
| Rate for Payer: Mclaren Commercial |
$1,077.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.83
|
| Rate for Payer: Nomi Health Commercial |
$981.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.76
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
OP
|
$1,197.45
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,197.45 |
| Rate for Payer: Aetna Commercial |
$1,077.70
|
| 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 |
$1,161.53
|
| Rate for Payer: ASR Commercial |
$1,161.53
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$980.59
|
| Rate for Payer: BCN Commercial |
$928.38
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cofinity Commercial |
$1,125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,197.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,077.70
|
| 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 |
$1,017.83
|
| Rate for Payer: Nomi Health Commercial |
$981.91
|
| 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 |
$778.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.21
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$839.41
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.76
|
| 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 NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
IP
|
$1,363.87
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.52 |
| Max. Negotiated Rate |
$1,363.87 |
| Rate for Payer: Aetna Commercial |
$1,227.48
|
| Rate for Payer: ASR ASR |
$1,322.95
|
| Rate for Payer: ASR Commercial |
$1,322.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.42
|
| Rate for Payer: BCN Commercial |
$1,057.41
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cofinity Commercial |
$1,282.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,091.10
|
| Rate for Payer: Healthscope Commercial |
$1,363.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.95
|
| Rate for Payer: Mclaren Commercial |
$1,227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.29
|
| Rate for Payer: Nomi Health Commercial |
$1,118.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,200.21
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,363.87
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,363.87 |
| Rate for Payer: Aetna Commercial |
$1,227.48
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$1,322.95
|
| Rate for Payer: ASR Commercial |
$1,322.95
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.87
|
| Rate for Payer: BCN Commercial |
$1,057.41
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cofinity Commercial |
$1,282.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,091.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,363.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren Commercial |
$1,227.48
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.29
|
| Rate for Payer: Nomi Health Commercial |
$1,118.37
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.02
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$956.07
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,200.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
IP
|
$1,204.40
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.86 |
| Max. Negotiated Rate |
$1,204.40 |
| Rate for Payer: Aetna Commercial |
$1,083.96
|
| Rate for Payer: ASR ASR |
$1,168.27
|
| Rate for Payer: ASR Commercial |
$1,168.27
|
| Rate for Payer: BCBS Trust/PPO |
$981.47
|
| Rate for Payer: BCN Commercial |
$933.77
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Healthscope Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.27
|
| Rate for Payer: Mclaren Commercial |
$1,083.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: Nomi Health Commercial |
$987.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.87
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
OP
|
$1,204.40
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,204.40 |
| Rate for Payer: Aetna Commercial |
$1,083.96
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$1,168.27
|
| Rate for Payer: ASR Commercial |
$1,168.27
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$986.28
|
| Rate for Payer: BCN Commercial |
$933.77
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren Commercial |
$1,083.96
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: Nomi Health Commercial |
$987.61
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,055.30
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$844.28
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
IP
|
$1,491.41
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$969.42 |
| Max. Negotiated Rate |
$1,491.41 |
| Rate for Payer: Aetna Commercial |
$1,342.27
|
| Rate for Payer: ASR ASR |
$1,446.67
|
| Rate for Payer: ASR Commercial |
$1,446.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,215.35
|
| Rate for Payer: BCN Commercial |
$1,156.29
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cofinity Commercial |
$1,401.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.13
|
| Rate for Payer: Healthscope Commercial |
$1,491.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,446.67
|
| Rate for Payer: Mclaren Commercial |
$1,342.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,267.70
|
| Rate for Payer: Nomi Health Commercial |
$1,222.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,312.44
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
OP
|
$1,491.41
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$1,491.41 |
| Rate for Payer: Aetna Commercial |
$1,342.27
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,446.67
|
| Rate for Payer: ASR Commercial |
$1,446.67
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.32
|
| Rate for Payer: BCN Commercial |
$1,156.29
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cofinity Commercial |
$1,401.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,491.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,446.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,342.27
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,267.70
|
| Rate for Payer: Nomi Health Commercial |
$1,222.96
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,306.77
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,045.48
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,312.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
OP
|
$758.70
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$682.83
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$735.94
|
| Rate for Payer: ASR Commercial |
$735.94
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$621.30
|
| Rate for Payer: BCN Commercial |
$588.22
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cofinity Commercial |
$713.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$758.70
|
| Rate for Payer: Healthscope Whirlpool |
$735.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$682.83
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.89
|
| Rate for Payer: Nomi Health Commercial |
$622.13
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.77
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$531.85
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
IP
|
$758.70
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.15 |
| Max. Negotiated Rate |
$758.70 |
| Rate for Payer: Aetna Commercial |
$682.83
|
| Rate for Payer: ASR ASR |
$735.94
|
| Rate for Payer: ASR Commercial |
$735.94
|
| Rate for Payer: BCBS Trust/PPO |
$618.26
|
| Rate for Payer: BCN Commercial |
$588.22
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cofinity Commercial |
$713.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.96
|
| Rate for Payer: Healthscope Commercial |
$758.70
|
| Rate for Payer: Healthscope Whirlpool |
$735.94
|
| Rate for Payer: Mclaren Commercial |
$682.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.89
|
| Rate for Payer: Nomi Health Commercial |
$622.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.66
|
|
|
HC NETTLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
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 NETTLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
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 NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
OP
|
$135.25
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$135.25 |
| Rate for Payer: Aetna Commercial |
$121.72
|
| Rate for Payer: Aetna Medicare |
$67.62
|
| Rate for Payer: ASR ASR |
$131.19
|
| Rate for Payer: ASR Commercial |
$131.19
|
| Rate for Payer: BCBS Complete |
$54.10
|
| Rate for Payer: BCBS Trust/PPO |
$110.76
|
| Rate for Payer: BCN Commercial |
$104.86
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Healthscope Commercial |
$135.25
|
| Rate for Payer: Healthscope Whirlpool |
$131.19
|
| Rate for Payer: Mclaren Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.51
|
| Rate for Payer: Priority Health Narrow Network |
$94.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.02
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
IP
|
$135.25
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$135.25 |
| Rate for Payer: Aetna Commercial |
$121.72
|
| Rate for Payer: ASR ASR |
$131.19
|
| Rate for Payer: ASR Commercial |
$131.19
|
| Rate for Payer: BCBS Trust/PPO |
$110.22
|
| Rate for Payer: BCN Commercial |
$104.86
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Healthscope Commercial |
$135.25
|
| Rate for Payer: Healthscope Whirlpool |
$131.19
|
| Rate for Payer: Mclaren Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.02
|
|
