|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$12.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.73
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$10.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$16.09
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: ASR ASR |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Commercial |
$13.21
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$16.09
|
| Rate for Payer: Mclaren Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.68
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.16
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$16.09
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$21.18 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: ASR ASR |
$15.61
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$16.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.95
|
| Rate for Payer: Mclaren Commercial |
$14.48
|
| Rate for Payer: Mclaren Medicaid |
$3.95
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.68
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.07
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicaid |
$2.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.18
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.95
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicaid |
$2.07
|
| Rate for Payer: UHCCP DNSP |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC POC URINE PREG TEST
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.40
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
|
|
HC POC URINE PREG TEST
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Complete |
$4.73
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCCCP Commercial |
$8.61
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.61
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$4.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$9.47
|
| Rate for Payer: PHP Medicaid |
$4.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.61
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHCCP DNSP |
$8.61
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.28
|
| Rate for Payer: ASR ASR |
$50.77
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$43.15
|
| Rate for Payer: BCN Commercial |
$43.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.82
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$5.82
|
| Rate for Payer: Mclaren Medicare |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Meridian Medicaid |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$6.40
|
| Rate for Payer: PHP Medicaid |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.82
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicaid |
$3.04
|
| Rate for Payer: UHCCP DNSP |
$5.82
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$5.82
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| Rate for Payer: ASR ASR |
$50.77
|
| Rate for Payer: BCBS Trust/PPO |
$42.98
|
| Rate for Payer: BCN Commercial |
$42.98
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$279.65
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Complete |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$230.57
|
| Rate for Payer: BCN Commercial |
$230.57
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.03
|
| Rate for Payer: Priority Health Narrow Network |
$196.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$279.65
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: ASR ASR |
$271.26
|
| Rate for Payer: BCBS Trust/PPO |
$229.65
|
| Rate for Payer: BCN Commercial |
$229.65
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$262.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$271.26
|
| Rate for Payer: Healthscope Whirlpool |
$279.65
|
| Rate for Payer: Mclaren Commercial |
$251.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Nomi Health Commercial |
$229.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.09
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$39.92
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: ASR ASR |
$43.03
|
| Rate for Payer: BCBS Complete |
$17.74
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$36.57
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Commercial |
$41.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$43.03
|
| Rate for Payer: Healthscope Whirlpool |
$44.36
|
| Rate for Payer: Mclaren Commercial |
$39.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.36
|
| Rate for Payer: Priority Health Narrow Network |
$43.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.04
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$44.36 |
| Rate for Payer: Aetna Commercial |
$39.92
|
| Rate for Payer: ASR ASR |
$43.03
|
| Rate for Payer: BCBS Trust/PPO |
$36.43
|
| Rate for Payer: BCN Commercial |
$36.43
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Commercial |
$41.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$43.03
|
| Rate for Payer: Healthscope Whirlpool |
$44.36
|
| Rate for Payer: Mclaren Commercial |
$39.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.04
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$545.16 |
| Rate for Payer: Aetna Commercial |
$490.64
|
| Rate for Payer: Aetna Medicare |
$201.71
|
| Rate for Payer: ASR ASR |
$528.81
|
| Rate for Payer: BCBS Complete |
$218.06
|
| Rate for Payer: BCBS Trust/PPO |
$449.48
|
| Rate for Payer: BCN Commercial |
$449.48
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$512.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$528.81
|
| Rate for Payer: Healthscope Whirlpool |
$545.16
|
| Rate for Payer: Mclaren Commercial |
$490.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.67
|
| Rate for Payer: Priority Health Narrow Network |
$382.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.74
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.87 |
| Max. Negotiated Rate |
$545.16 |
| Rate for Payer: Aetna Commercial |
$490.64
|
| Rate for Payer: ASR ASR |
$528.81
|
| Rate for Payer: BCBS Trust/PPO |
$447.69
|
| Rate for Payer: BCN Commercial |
$447.69
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$512.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$528.81
|
| Rate for Payer: Healthscope Whirlpool |
$545.16
|
| Rate for Payer: Mclaren Commercial |
$490.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.74
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$186.38 |
| Rate for Payer: Aetna Commercial |
$167.74
|
| Rate for Payer: ASR ASR |
$180.79
|
| Rate for Payer: BCBS Trust/PPO |
$153.06
|
| Rate for Payer: BCN Commercial |
$153.06
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Healthscope Whirlpool |
$186.38
|
| Rate for Payer: Mclaren Commercial |
$167.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Nomi Health Commercial |
$152.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.01
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$186.38 |
| Rate for Payer: Aetna Commercial |
$167.74
|
| Rate for Payer: Aetna Medicare |
$68.96
|
| Rate for Payer: ASR ASR |
$180.79
|
| Rate for Payer: BCBS Complete |
$74.55
|
| Rate for Payer: BCBS Trust/PPO |
$153.67
|
| Rate for Payer: BCN Commercial |
$153.67
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Healthscope Whirlpool |
$186.38
|
| Rate for Payer: Mclaren Commercial |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Nomi Health Commercial |
$152.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$163.31
|
| Rate for Payer: Priority Health Narrow Network |
$130.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.01
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$214.26 |
| Rate for Payer: Aetna Commercial |
$30.56
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: ASR ASR |
$32.94
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$28.00
|
| Rate for Payer: BCN Commercial |
$28.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Whirlpool |
$33.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.71
|
| Rate for Payer: Mclaren Commercial |
$30.56
|
| Rate for Payer: Mclaren Medicaid |
$14.71
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$8.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Medicaid |
$7.88
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$214.26
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$171.41
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.71
|
| Rate for Payer: UHC Exchange |
$22.80
|
| Rate for Payer: UHC Medicaid |
$7.69
|
| Rate for Payer: UHCCP DNSP |
$14.71
|
| Rate for Payer: UHCCP Medicaid |
$7.69
|
| Rate for Payer: VA VA |
$14.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$30.56
|
| Rate for Payer: ASR ASR |
$32.94
|
| Rate for Payer: BCBS Trust/PPO |
$27.89
|
| Rate for Payer: BCN Commercial |
$27.89
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Whirlpool |
$33.96
|
| Rate for Payer: Mclaren Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.88
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.48
|
| Rate for Payer: BCN Commercial |
$26.48
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$26.59
|
| Rate for Payer: BCN Commercial |
$26.59
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.44
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$4.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: PHP Medicaid |
$4.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$124.68
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Narrow Network |
$99.74
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.44
|
| Rate for Payer: UHC Exchange |
$13.08
|
| Rate for Payer: UHC Medicaid |
$4.41
|
| Rate for Payer: UHCCP DNSP |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$4.41
|
| Rate for Payer: VA VA |
$8.44
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$204.55 |
| Max. Negotiated Rate |
$272.73 |
| Rate for Payer: Aetna Commercial |
$245.46
|
| Rate for Payer: ASR ASR |
$264.55
|
| Rate for Payer: BCBS Trust/PPO |
$223.97
|
| Rate for Payer: BCN Commercial |
$223.97
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Commercial |
$256.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Healthscope Commercial |
$264.55
|
| Rate for Payer: Healthscope Whirlpool |
$272.73
|
| Rate for Payer: Mclaren Commercial |
$245.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Nomi Health Commercial |
$223.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.00
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$100.91 |
| Max. Negotiated Rate |
$272.73 |
| Rate for Payer: Aetna Commercial |
$245.46
|
| Rate for Payer: Aetna Medicare |
$100.91
|
| Rate for Payer: ASR ASR |
$264.55
|
| Rate for Payer: BCBS Complete |
$109.09
|
| Rate for Payer: BCBS Trust/PPO |
$224.87
|
| Rate for Payer: BCN Commercial |
$224.87
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Commercial |
$256.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Healthscope Commercial |
$264.55
|
| Rate for Payer: Healthscope Whirlpool |
$272.73
|
| Rate for Payer: Mclaren Commercial |
$245.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Nomi Health Commercial |
$223.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$238.97
|
| Rate for Payer: Priority Health Narrow Network |
$191.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.00
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$423.42 |
| Max. Negotiated Rate |
$564.56 |
| Rate for Payer: Aetna Commercial |
$508.10
|
| Rate for Payer: ASR ASR |
$547.62
|
| Rate for Payer: BCBS Trust/PPO |
$463.62
|
| Rate for Payer: BCN Commercial |
$463.62
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Commercial |
$530.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Healthscope Commercial |
$547.62
|
| Rate for Payer: Healthscope Whirlpool |
$564.56
|
| Rate for Payer: Mclaren Commercial |
$508.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Nomi Health Commercial |
$462.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.81
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$578.27 |
| Rate for Payer: Aetna Commercial |
$508.10
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$547.62
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$465.48
|
| Rate for Payer: BCN Commercial |
$465.48
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Commercial |
$530.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$547.62
|
| Rate for Payer: Healthscope Whirlpool |
$564.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$508.10
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Nomi Health Commercial |
$462.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$494.67
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$395.76
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$351.05 |
| Max. Negotiated Rate |
$1,715.94 |
| Rate for Payer: Aetna Commercial |
$1,544.35
|
| Rate for Payer: Aetna Medicare |
$671.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$839.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$839.02
|
| Rate for Payer: ASR ASR |
$1,664.46
|
| Rate for Payer: BCBS Complete |
$368.63
|
| Rate for Payer: BCBS MAPPO |
$671.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.79
|
| Rate for Payer: BCN Commercial |
$1,414.79
|
| Rate for Payer: BCN Medicare Advantage |
$671.22
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Commercial |
$1,612.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.22
|
| Rate for Payer: Healthscope Commercial |
$1,664.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$671.22
|
| Rate for Payer: Mclaren Commercial |
$1,544.35
|
| Rate for Payer: Mclaren Medicaid |
$671.22
|
| Rate for Payer: Mclaren Medicare |
$671.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.78
|
| Rate for Payer: Meridian Medicaid |
$368.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$771.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$738.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Nomi Health Commercial |
$1,407.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: PACE Medicare |
$637.66
|
| Rate for Payer: PACE SWMI |
$671.22
|
| Rate for Payer: PHP Commercial |
$738.34
|
| Rate for Payer: PHP Medicaid |
$359.77
|
| Rate for Payer: PHP Medicare Advantage |
$671.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,503.51
|
| Rate for Payer: Priority Health Medicare |
$671.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,202.87
|
| Rate for Payer: Railroad Medicare Medicare |
$671.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,510.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$671.22
|
| Rate for Payer: UHC Exchange |
$1,040.39
|
| Rate for Payer: UHC Medicaid |
$351.05
|
| Rate for Payer: UHCCP DNSP |
$671.22
|
| Rate for Payer: UHCCP Medicaid |
$351.05
|
| Rate for Payer: VA VA |
$671.22
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,286.95 |
| Max. Negotiated Rate |
$1,715.94 |
| Rate for Payer: Aetna Commercial |
$1,544.35
|
| Rate for Payer: ASR ASR |
$1,664.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,409.13
|
| Rate for Payer: BCN Commercial |
$1,409.13
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Commercial |
$1,612.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Healthscope Commercial |
$1,664.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.94
|
| Rate for Payer: Mclaren Commercial |
$1,544.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Nomi Health Commercial |
$1,407.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,510.03
|
|
