|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$168.88
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$126.66 |
| Max. Negotiated Rate |
$168.88 |
| Rate for Payer: Aetna Commercial |
$151.99
|
| Rate for Payer: ASR ASR |
$163.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.68
|
| Rate for Payer: BCN Commercial |
$138.68
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.10
|
| Rate for Payer: Healthscope Commercial |
$163.81
|
| Rate for Payer: Healthscope Whirlpool |
$168.88
|
| Rate for Payer: Mclaren Commercial |
$151.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.55
|
| Rate for Payer: Nomi Health Commercial |
$138.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.61
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$4,074.08 |
| Max. Negotiated Rate |
$5,432.11 |
| Rate for Payer: Aetna Commercial |
$4,888.90
|
| Rate for Payer: ASR ASR |
$5,269.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,460.85
|
| Rate for Payer: BCN Commercial |
$4,460.85
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Commercial |
$5,106.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Healthscope Commercial |
$5,269.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,432.11
|
| Rate for Payer: Mclaren Commercial |
$4,888.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Nomi Health Commercial |
$4,454.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,780.26
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$4,074.08 |
| Max. Negotiated Rate |
$5,432.11 |
| Rate for Payer: Aetna Commercial |
$4,888.90
|
| Rate for Payer: ASR ASR |
$5,269.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,460.85
|
| Rate for Payer: BCN Commercial |
$4,460.85
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Commercial |
$5,106.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Healthscope Commercial |
$5,269.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,432.11
|
| Rate for Payer: Mclaren Commercial |
$4,888.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Nomi Health Commercial |
$4,454.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,780.26
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.90
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: ASR ASR |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$18.81
|
| Rate for Payer: BCN Commercial |
$18.81
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Healthscope Whirlpool |
$22.90
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.15
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.90
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: ASR ASR |
$22.21
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$18.88
|
| Rate for Payer: BCN Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Healthscope Whirlpool |
$22.90
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health Narrow Network |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.15
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$168.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$168.60 |
| Rate for Payer: Aetna Commercial |
$151.74
|
| Rate for Payer: ASR ASR |
$163.54
|
| Rate for Payer: BCBS Trust/PPO |
$138.45
|
| Rate for Payer: BCN Commercial |
$138.45
|
| Rate for Payer: Cash Price |
$134.88
|
| Rate for Payer: Cofinity Commercial |
$158.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.88
|
| Rate for Payer: Healthscope Commercial |
$163.54
|
| Rate for Payer: Healthscope Whirlpool |
$168.60
|
| Rate for Payer: Mclaren Commercial |
$151.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.31
|
| Rate for Payer: Nomi Health Commercial |
$138.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.37
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$168.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$168.60 |
| Rate for Payer: Aetna Commercial |
$151.74
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$163.54
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$139.01
|
| Rate for Payer: BCN Commercial |
$139.01
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$134.88
|
| Rate for Payer: Cash Price |
$134.88
|
| Rate for Payer: Cofinity Commercial |
$158.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$163.54
|
| Rate for Payer: Healthscope Whirlpool |
$168.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$151.74
|
| Rate for Payer: Mclaren Medicaid |
$23.57
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.31
|
| Rate for Payer: Nomi Health Commercial |
$138.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.45
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.73
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$118.19
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$91.91
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$250.58 |
| Rate for Payer: Aetna Commercial |
$82.72
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$89.15
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.78
|
| Rate for Payer: BCN Commercial |
$75.78
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$86.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$89.15
|
| Rate for Payer: Healthscope Whirlpool |
$91.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$82.72
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$75.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$91.91
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.93 |
| Max. Negotiated Rate |
$91.91 |
| Rate for Payer: Aetna Commercial |
$82.72
|
| Rate for Payer: ASR ASR |
$89.15
|
| Rate for Payer: BCBS Trust/PPO |
$75.48
|
| Rate for Payer: BCN Commercial |
$75.48
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$86.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$89.15
|
| Rate for Payer: Healthscope Whirlpool |
$91.91
|
| Rate for Payer: Mclaren Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$75.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.88
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$274.46
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$205.84 |
| Max. Negotiated Rate |
$274.46 |
| Rate for Payer: Aetna Commercial |
$247.01
|
| Rate for Payer: ASR ASR |
$266.23
|
| Rate for Payer: BCBS Trust/PPO |
$225.39
|
| Rate for Payer: BCN Commercial |
$225.39
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Commercial |
$257.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Healthscope Commercial |
$266.23
|
| Rate for Payer: Healthscope Whirlpool |
$274.46
|
| Rate for Payer: Mclaren Commercial |
$247.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$225.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.52
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$274.46
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$274.46 |
| Rate for Payer: Aetna Commercial |
$247.01
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: ASR ASR |
$266.23
|
| Rate for Payer: BCBS Complete |
$20.72
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$226.29
|
| Rate for Payer: BCN Commercial |
$226.29
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Commercial |
$257.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$266.23
|
| Rate for Payer: Healthscope Whirlpool |
$274.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$247.01
|
| Rate for Payer: Mclaren Medicaid |
$37.73
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$20.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$225.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicaid |
$20.22
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.48
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$192.40
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.73
|
| Rate for Payer: UHC Exchange |
$58.48
|
| Rate for Payer: UHC Medicaid |
$19.73
|
| Rate for Payer: UHCCP DNSP |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$19.73
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$205.84 |
| Max. Negotiated Rate |
$274.46 |
| Rate for Payer: Aetna Commercial |
$247.01
|
| Rate for Payer: ASR ASR |
$266.23
|
| Rate for Payer: BCBS Trust/PPO |
$225.39
|
| Rate for Payer: BCN Commercial |
$225.39
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Commercial |
$257.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Healthscope Commercial |
$266.23
|
| Rate for Payer: Healthscope Whirlpool |
$274.46
|
| Rate for Payer: Mclaren Commercial |
$247.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$225.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.52
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$274.46 |
| Rate for Payer: Aetna Commercial |
$247.01
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: ASR ASR |
$266.23
|
| Rate for Payer: BCBS Complete |
$20.72
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$226.29
|
| Rate for Payer: BCN Commercial |
$226.29
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Commercial |
$257.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$266.23
|
| Rate for Payer: Healthscope Whirlpool |
$274.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$247.01
|
| Rate for Payer: Mclaren Medicaid |
$37.73
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$20.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$225.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicaid |
$20.22
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.48
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$192.40
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.73
|
| Rate for Payer: UHC Exchange |
$58.48
|
| Rate for Payer: UHC Medicaid |
$19.73
|
| Rate for Payer: UHCCP DNSP |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$19.73
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,689.03
|
| Rate for Payer: BCN Commercial |
$1,689.03
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,925.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$299.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,649.99
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,319.99
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,536.41 |
| Max. Negotiated Rate |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,682.27
|
| Rate for Payer: BCN Commercial |
$1,682.27
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,925.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$631.54 |
| Max. Negotiated Rate |
$842.06 |
| Rate for Payer: Aetna Commercial |
$757.85
|
| Rate for Payer: ASR ASR |
$816.80
|
| Rate for Payer: BCBS Trust/PPO |
$691.50
|
| Rate for Payer: BCN Commercial |
$691.50
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Commercial |
$791.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Healthscope Commercial |
$816.80
|
| Rate for Payer: Healthscope Whirlpool |
$842.06
|
| Rate for Payer: Mclaren Commercial |
$757.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$690.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.01
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$842.06 |
| Rate for Payer: Aetna Commercial |
$757.85
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$816.80
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$694.28
|
| Rate for Payer: BCN Commercial |
$694.28
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Commercial |
$791.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$816.80
|
| Rate for Payer: Healthscope Whirlpool |
$842.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$757.85
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$690.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$602.26
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$481.81
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,272.84 |
| Max. Negotiated Rate |
$1,697.12 |
| Rate for Payer: Aetna Commercial |
$1,527.41
|
| Rate for Payer: ASR ASR |
$1,646.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.67
|
| Rate for Payer: BCN Commercial |
$1,393.67
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Commercial |
$1,595.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Healthscope Commercial |
$1,646.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,697.12
|
| Rate for Payer: Mclaren Commercial |
$1,527.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Nomi Health Commercial |
$1,391.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.47
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$1,697.12 |
| Rate for Payer: Aetna Commercial |
$1,527.41
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,646.21
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.28
|
| Rate for Payer: BCN Commercial |
$1,399.28
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Commercial |
$1,595.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,646.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,697.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,527.41
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Nomi Health Commercial |
$1,391.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,487.02
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.68
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| 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 PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$160.00 |
| 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: 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 |
$140.19
|
| Rate for Payer: Priority Health Narrow Network |
$112.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,163.94 |
| Max. Negotiated Rate |
$1,551.92 |
| Rate for Payer: Aetna Commercial |
$1,396.73
|
| Rate for Payer: ASR ASR |
$1,505.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.44
|
| Rate for Payer: BCN Commercial |
$1,274.44
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Commercial |
$1,458.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Healthscope Commercial |
$1,505.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,551.92
|
| Rate for Payer: Mclaren Commercial |
$1,396.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Nomi Health Commercial |
$1,272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.69
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$4,454.85 |
| Rate for Payer: Aetna Commercial |
$1,396.73
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$1,505.36
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,279.56
|
| Rate for Payer: BCN Commercial |
$1,279.56
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Commercial |
$1,458.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,505.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,551.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$1,396.73
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Nomi Health Commercial |
$1,272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,454.85
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,563.88
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$3,898.00 |
| Rate for Payer: Aetna Commercial |
$1,207.36
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$1,301.26
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.07
|
| Rate for Payer: BCN Commercial |
$1,106.07
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Commercial |
$1,261.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,301.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$1,207.36
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Nomi Health Commercial |
$1,100.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,898.00
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,118.40
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,180.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,006.13 |
| Max. Negotiated Rate |
$1,341.51 |
| Rate for Payer: Aetna Commercial |
$1,207.36
|
| Rate for Payer: ASR ASR |
$1,301.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.65
|
| Rate for Payer: BCN Commercial |
$1,101.65
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Commercial |
$1,261.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Healthscope Commercial |
$1,301.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.51
|
| Rate for Payer: Mclaren Commercial |
$1,207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Nomi Health Commercial |
$1,100.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,180.53
|
|
