|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$227.29 |
| Rate for Payer: Aetna Commercial |
$81.10
|
| 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 |
$87.41
|
| Rate for Payer: ASR Commercial |
$87.41
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$73.79
|
| Rate for Payer: BCN Commercial |
$69.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$90.11
|
| Rate for Payer: Healthscope Whirlpool |
$87.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$81.10
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: Nomi Health Commercial |
$73.89
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.90 |
| Max. Negotiated Rate |
$269.08 |
| Rate for Payer: Aetna Commercial |
$242.17
|
| Rate for Payer: ASR ASR |
$261.01
|
| Rate for Payer: ASR Commercial |
$261.01
|
| Rate for Payer: BCBS Trust/PPO |
$219.27
|
| Rate for Payer: BCN Commercial |
$208.62
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$252.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$269.08
|
| Rate for Payer: Healthscope Whirlpool |
$261.01
|
| Rate for Payer: Mclaren Commercial |
$242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.79
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$269.08 |
| Rate for Payer: Aetna Commercial |
$242.17
|
| 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 |
$261.01
|
| Rate for Payer: ASR Commercial |
$261.01
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$220.35
|
| Rate for Payer: BCN Commercial |
$208.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$252.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$269.08
|
| Rate for Payer: Healthscope Whirlpool |
$261.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$242.17
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| 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 |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| 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 |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.77
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$188.63
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$58.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP DNSP |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$20.22
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.90 |
| Max. Negotiated Rate |
$269.08 |
| Rate for Payer: Aetna Commercial |
$242.17
|
| Rate for Payer: ASR ASR |
$261.01
|
| Rate for Payer: ASR Commercial |
$261.01
|
| Rate for Payer: BCBS Trust/PPO |
$219.27
|
| Rate for Payer: BCN Commercial |
$208.62
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$252.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$269.08
|
| Rate for Payer: Healthscope Whirlpool |
$261.01
|
| Rate for Payer: Mclaren Commercial |
$242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.79
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$269.08 |
| Rate for Payer: Aetna Commercial |
$242.17
|
| 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 |
$261.01
|
| Rate for Payer: ASR Commercial |
$261.01
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$220.35
|
| Rate for Payer: BCN Commercial |
$208.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$252.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$269.08
|
| Rate for Payer: Healthscope Whirlpool |
$261.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$242.17
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| 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 |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| 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 |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.77
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$188.63
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$58.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP DNSP |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$20.22
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,305.45 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.63
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,496.59
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.27
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.61 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$743.00
|
| Rate for Payer: ASR ASR |
$800.78
|
| Rate for Payer: ASR Commercial |
$800.78
|
| Rate for Payer: BCBS Trust/PPO |
$672.74
|
| Rate for Payer: BCN Commercial |
$640.05
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$776.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$825.55
|
| Rate for Payer: Healthscope Whirlpool |
$800.78
|
| Rate for Payer: Mclaren Commercial |
$743.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.48
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$743.00
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$800.78
|
| Rate for Payer: ASR Commercial |
$800.78
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$676.04
|
| Rate for Payer: BCN Commercial |
$640.05
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$776.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$825.55
|
| Rate for Payer: Healthscope Whirlpool |
$800.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.27
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$437.02
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$1,663.84 |
| Rate for Payer: Aetna Commercial |
$1,497.46
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$1,613.92
|
| Rate for Payer: ASR Commercial |
$1,613.92
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.52
|
| Rate for Payer: BCN Commercial |
$1,289.98
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,663.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,613.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$1,497.46
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$1,364.35
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,457.86
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,166.35
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$1,663.84 |
| Rate for Payer: Aetna Commercial |
$1,497.46
|
| Rate for Payer: ASR ASR |
$1,613.92
|
| Rate for Payer: ASR Commercial |
$1,613.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.86
|
| Rate for Payer: BCN Commercial |
$1,289.98
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Healthscope Commercial |
$1,663.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,613.92
|
| Rate for Payer: Mclaren Commercial |
$1,497.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$1,364.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,464.18
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$101.65 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: ASR Commercial |
$151.69
|
| Rate for Payer: BCBS Trust/PPO |
$127.43
|
| Rate for Payer: BCN Commercial |
$121.24
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Healthscope Whirlpool |
$151.69
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.61
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: ASR Commercial |
$151.69
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: BCBS Trust/PPO |
$128.06
|
| Rate for Payer: BCN Commercial |
$121.24
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Healthscope Whirlpool |
$151.69
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow Network |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.61
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$988.97 |
| Max. Negotiated Rate |
$1,521.49 |
| Rate for Payer: Aetna Commercial |
$1,369.34
|
| Rate for Payer: ASR ASR |
$1,475.85
|
| Rate for Payer: ASR Commercial |
$1,475.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.86
|
| Rate for Payer: BCN Commercial |
$1,179.61
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,430.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Healthscope Commercial |
$1,521.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.85
|
| Rate for Payer: Mclaren Commercial |
$1,369.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.91
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$347.18 |
| Max. Negotiated Rate |
$4,040.68 |
| Rate for Payer: Aetna Commercial |
$1,369.34
|
| Rate for Payer: Aetna Medicare |
$647.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: ASR ASR |
$1,475.85
|
| Rate for Payer: ASR Commercial |
$1,475.85
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.95
|
| Rate for Payer: BCN Commercial |
$1,179.61
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,430.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,521.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$647.73
|
| Rate for Payer: Mclaren Commercial |
$1,369.34
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$712.50
|
| Rate for Payer: PHP Medicaid |
$347.18
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,040.68
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$3,232.54
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$1,003.98
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP DNSP |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: VA VA |
$647.73
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$854.89 |
| Max. Negotiated Rate |
$1,315.21 |
| Rate for Payer: Aetna Commercial |
$1,183.69
|
| Rate for Payer: ASR ASR |
$1,275.75
|
| Rate for Payer: ASR Commercial |
$1,275.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,071.76
|
| Rate for Payer: BCN Commercial |
$1,019.68
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,236.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Healthscope Commercial |
$1,315.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.75
|
| Rate for Payer: Mclaren Commercial |
$1,183.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,157.38
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$347.18 |
| Max. Negotiated Rate |
$3,535.60 |
| Rate for Payer: Aetna Commercial |
$1,183.69
|
| Rate for Payer: Aetna Medicare |
$647.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: ASR ASR |
$1,275.75
|
| Rate for Payer: ASR Commercial |
$1,275.75
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.03
|
| Rate for Payer: BCN Commercial |
$1,019.68
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,236.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,315.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$647.73
|
| Rate for Payer: Mclaren Commercial |
$1,183.69
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$712.50
|
| Rate for Payer: PHP Medicaid |
$347.18
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,535.60
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$2,828.48
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,157.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$1,003.98
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP DNSP |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: VA VA |
$647.73
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$1,210.85 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Medicare |
$605.42
|
| Rate for Payer: ASR ASR |
$1,174.52
|
| Rate for Payer: ASR Commercial |
$1,174.52
|
| Rate for Payer: BCBS Complete |
$484.34
|
| Rate for Payer: BCBS Trust/PPO |
$991.57
|
| Rate for Payer: BCN Commercial |
$938.77
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,138.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,210.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.52
|
| Rate for Payer: Mclaren Commercial |
$1,089.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.95
|
| Rate for Payer: Priority Health Narrow Network |
$848.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.55
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.05 |
| Max. Negotiated Rate |
$1,210.85 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: ASR ASR |
$1,174.52
|
| Rate for Payer: ASR Commercial |
$1,174.52
|
| Rate for Payer: BCBS Trust/PPO |
$986.72
|
| Rate for Payer: BCN Commercial |
$938.77
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,138.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,210.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.52
|
| Rate for Payer: Mclaren Commercial |
$1,089.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.55
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.27 |
| Max. Negotiated Rate |
$1,525.03 |
| Rate for Payer: Aetna Commercial |
$1,372.53
|
| Rate for Payer: ASR ASR |
$1,479.28
|
| Rate for Payer: ASR Commercial |
$1,479.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.75
|
| Rate for Payer: BCN Commercial |
$1,182.36
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,433.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,525.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.28
|
| Rate for Payer: Mclaren Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.03
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.01 |
| Max. Negotiated Rate |
$1,525.03 |
| Rate for Payer: Aetna Commercial |
$1,372.53
|
| Rate for Payer: Aetna Medicare |
$762.52
|
| Rate for Payer: ASR ASR |
$1,479.28
|
| Rate for Payer: ASR Commercial |
$1,479.28
|
| Rate for Payer: BCBS Complete |
$610.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.85
|
| Rate for Payer: BCN Commercial |
$1,182.36
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,433.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,525.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.28
|
| Rate for Payer: Mclaren Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,336.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.03
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: ASR Commercial |
$45.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.30
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: ASR Commercial |
$45.59
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCCCP Commercial |
$19.64
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.18
|
| Rate for Payer: Priority Health Narrow Network |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 PENICILLIUM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| 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
|
|
