|
HC PEANUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PEANUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PECAN NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PECAN NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
IP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Trust/PPO |
$105.14
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
OP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: Aetna Medicare |
$64.51
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: BCBS Trust/PPO |
$105.65
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.05
|
| Rate for Payer: Priority Health Narrow Network |
$90.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna Commercial |
$149.01
|
| Rate for Payer: Aetna Medicare |
$82.78
|
| Rate for Payer: ASR ASR |
$160.60
|
| Rate for Payer: ASR Commercial |
$160.60
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.59
|
| Rate for Payer: BCN Commercial |
$128.37
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$165.57
|
| Rate for Payer: Healthscope Whirlpool |
$160.60
|
| Rate for Payer: Mclaren Commercial |
$149.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.07
|
| Rate for Payer: Priority Health Narrow Network |
$116.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.70
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna Commercial |
$149.01
|
| Rate for Payer: ASR ASR |
$160.60
|
| Rate for Payer: ASR Commercial |
$160.60
|
| Rate for Payer: BCBS Trust/PPO |
$134.92
|
| Rate for Payer: BCN Commercial |
$128.37
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$165.57
|
| Rate for Payer: Healthscope Whirlpool |
$160.60
|
| Rate for Payer: Mclaren Commercial |
$149.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.70
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$5,325.60 |
| Rate for Payer: Aetna Commercial |
$4,793.04
|
| Rate for Payer: ASR ASR |
$5,165.83
|
| Rate for Payer: ASR Commercial |
$5,165.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.83
|
| Rate for Payer: BCN Commercial |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$5,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$5,325.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,165.83
|
| Rate for Payer: Mclaren Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,686.53
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$5,325.60 |
| Rate for Payer: Aetna Commercial |
$4,793.04
|
| Rate for Payer: ASR ASR |
$5,165.83
|
| Rate for Payer: ASR Commercial |
$5,165.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.83
|
| Rate for Payer: BCN Commercial |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$5,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$5,325.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,165.83
|
| Rate for Payer: Mclaren Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,686.53
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: ASR ASR |
$21.78
|
| Rate for Payer: ASR Commercial |
$21.78
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.78
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.76
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: ASR ASR |
$21.78
|
| Rate for Payer: ASR Commercial |
$21.78
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.78
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.67
|
| Rate for Payer: Priority Health Narrow Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.76
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$165.29 |
| Rate for Payer: Aetna Commercial |
$148.76
|
| Rate for Payer: ASR ASR |
$160.33
|
| Rate for Payer: ASR Commercial |
$160.33
|
| Rate for Payer: BCBS Trust/PPO |
$134.69
|
| Rate for Payer: BCN Commercial |
$128.15
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Healthscope Commercial |
$165.29
|
| Rate for Payer: Healthscope Whirlpool |
$160.33
|
| Rate for Payer: Mclaren Commercial |
$148.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.46
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$165.29 |
| Rate for Payer: Aetna Commercial |
$148.76
|
| 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 |
$160.33
|
| Rate for Payer: ASR Commercial |
$160.33
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$135.36
|
| Rate for Payer: BCN Commercial |
$128.15
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$165.29
|
| Rate for Payer: Healthscope Whirlpool |
$160.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$148.76
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| 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 |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| 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 |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.83
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$115.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.57 |
| Max. Negotiated Rate |
$90.11 |
| Rate for Payer: Aetna Commercial |
$81.10
|
| Rate for Payer: ASR ASR |
$87.41
|
| Rate for Payer: ASR Commercial |
$87.41
|
| Rate for Payer: BCBS Trust/PPO |
$73.43
|
| Rate for Payer: BCN Commercial |
$69.86
|
| 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: Healthscope Commercial |
$90.11
|
| Rate for Payer: Healthscope Whirlpool |
$87.41
|
| Rate for Payer: Mclaren Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: Nomi Health Commercial |
$73.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.30
|
|
|
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 |
$90.11 |
| 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 |
$78.95
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$63.17
|
| 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 |
$286.63 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| 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 |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.74
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,407.87
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$743.00
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$800.78
|
| Rate for Payer: ASR Commercial |
$800.78
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$676.04
|
| Rate for Payer: BCN Commercial |
$640.05
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| 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 |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$825.55
|
| Rate for Payer: Healthscope Whirlpool |
$800.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.35
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$578.71
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
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 W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,663.84 |
| Rate for Payer: Aetna Commercial |
$1,497.46
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$1,613.92
|
| Rate for Payer: ASR Commercial |
$1,613.92
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.52
|
| Rate for Payer: BCN Commercial |
$1,289.98
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| 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 |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,663.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,613.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,497.46
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| 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 |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| 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 |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,166.35
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
