|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,161.18 |
| Max. Negotiated Rate |
$4,863.36 |
| Rate for Payer: Aetna Commercial |
$4,377.02
|
| Rate for Payer: ASR ASR |
$4,717.46
|
| Rate for Payer: ASR Commercial |
$4,717.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,963.15
|
| Rate for Payer: BCN Commercial |
$3,770.56
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$4,571.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Healthscope Commercial |
$4,863.36
|
| Rate for Payer: Healthscope Whirlpool |
$4,717.46
|
| Rate for Payer: Mclaren Commercial |
$4,377.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$3,987.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,279.76
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$4,328.06 |
| Rate for Payer: Aetna Commercial |
$3,895.25
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$4,198.22
|
| Rate for Payer: ASR Commercial |
$4,198.22
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,544.25
|
| Rate for Payer: BCN Commercial |
$3,355.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$4,068.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$4,328.06
|
| Rate for Payer: Healthscope Whirlpool |
$4,198.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$3,895.25
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,792.25
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,033.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,808.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,813.24 |
| Max. Negotiated Rate |
$4,328.06 |
| Rate for Payer: Aetna Commercial |
$3,895.25
|
| Rate for Payer: ASR ASR |
$4,198.22
|
| Rate for Payer: ASR Commercial |
$4,198.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,526.94
|
| Rate for Payer: BCN Commercial |
$3,355.54
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$4,068.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Healthscope Commercial |
$4,328.06
|
| Rate for Payer: Healthscope Whirlpool |
$4,198.22
|
| Rate for Payer: Mclaren Commercial |
$3,895.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,808.69
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,706.58 |
| Max. Negotiated Rate |
$5,702.43 |
| Rate for Payer: Aetna Commercial |
$5,132.19
|
| Rate for Payer: ASR ASR |
$5,531.36
|
| Rate for Payer: ASR Commercial |
$5,531.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,646.91
|
| Rate for Payer: BCN Commercial |
$4,421.09
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$5,360.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Healthscope Commercial |
$5,702.43
|
| Rate for Payer: Healthscope Whirlpool |
$5,531.36
|
| Rate for Payer: Mclaren Commercial |
$5,132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,018.14
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,702.43 |
| Rate for Payer: Aetna Commercial |
$5,132.19
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,531.36
|
| Rate for Payer: ASR Commercial |
$5,531.36
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,669.72
|
| Rate for Payer: BCN Commercial |
$4,421.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$5,360.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,702.43
|
| Rate for Payer: Healthscope Whirlpool |
$5,531.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$5,132.19
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,996.47
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,997.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,018.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,703.98 |
| Max. Negotiated Rate |
$7,236.90 |
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: ASR Commercial |
$7,019.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,897.35
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$7,236.90 |
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: ASR Commercial |
$7,019.79
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$5,926.30
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,340.97
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$5,073.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PFO
|
Facility
|
OP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$27,270.14 |
| Rate for Payer: Aetna Commercial |
$24,321.65
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$26,213.34
|
| Rate for Payer: ASR Commercial |
$26,213.34
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$22,130.00
|
| Rate for Payer: BCN Commercial |
$20,951.75
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$25,402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$27,024.06
|
| Rate for Payer: Healthscope Whirlpool |
$26,213.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$24,321.65
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,678.48
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$18,943.87
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,781.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC PFO
|
Facility
|
IP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,565.64 |
| Max. Negotiated Rate |
$27,024.06 |
| Rate for Payer: Aetna Commercial |
$24,321.65
|
| Rate for Payer: ASR ASR |
$26,213.34
|
| Rate for Payer: ASR Commercial |
$26,213.34
|
| Rate for Payer: BCBS Trust/PPO |
$22,021.91
|
| Rate for Payer: BCN Commercial |
$20,951.75
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$25,402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Healthscope Commercial |
$27,024.06
|
| Rate for Payer: Healthscope Whirlpool |
$26,213.34
|
| Rate for Payer: Mclaren Commercial |
$24,321.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,781.17
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,470.41
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,455.77 |
| Max. Negotiated Rate |
$11,470.41 |
| Rate for Payer: Aetna Commercial |
$10,323.37
|
| Rate for Payer: ASR ASR |
$11,126.30
|
| Rate for Payer: ASR Commercial |
$11,126.30
|
| Rate for Payer: BCBS Trust/PPO |
$9,347.24
|
| Rate for Payer: BCN Commercial |
$8,893.01
|
| Rate for Payer: Cash Price |
$9,176.33
|
| Rate for Payer: Cofinity Commercial |
$10,782.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,176.33
|
| Rate for Payer: Healthscope Commercial |
$11,470.41
|
| Rate for Payer: Healthscope Whirlpool |
$11,126.30
|
| Rate for Payer: Mclaren Commercial |
$10,323.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,749.85
|
| Rate for Payer: Nomi Health Commercial |
$9,405.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,455.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,093.96
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,470.41
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,588.16 |
| Max. Negotiated Rate |
$11,470.41 |
| Rate for Payer: Aetna Commercial |
$10,323.37
|
| Rate for Payer: Aetna Medicare |
$5,735.20
|
| Rate for Payer: ASR ASR |
$11,126.30
|
| Rate for Payer: ASR Commercial |
$11,126.30
|
| Rate for Payer: BCBS Complete |
$4,588.16
|
| Rate for Payer: BCBS Trust/PPO |
$9,393.12
|
| Rate for Payer: BCN Commercial |
$8,893.01
|
| Rate for Payer: Cash Price |
$9,176.33
|
| Rate for Payer: Cofinity Commercial |
$10,782.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,176.33
|
| Rate for Payer: Healthscope Commercial |
$11,470.41
|
| Rate for Payer: Healthscope Whirlpool |
$11,126.30
|
| Rate for Payer: Mclaren Commercial |
$10,323.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,749.85
|
| Rate for Payer: Nomi Health Commercial |
$9,405.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,455.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,050.37
|
| Rate for Payer: Priority Health Narrow Network |
$8,040.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,093.96
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,160.65
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,551.43 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: Aetna Medicare |
$1,939.28
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.16
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,398.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,718.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$276.82
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$276.82 |
| Rate for Payer: Aetna Commercial |
$249.14
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$268.52
|
| Rate for Payer: ASR Commercial |
$268.52
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$226.69
|
| Rate for Payer: BCN Commercial |
$214.62
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cofinity Commercial |
$260.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$276.82
|
| Rate for Payer: Healthscope Whirlpool |
$268.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$249.14
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.30
|
| Rate for Payer: Nomi Health Commercial |
$226.99
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.55
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$194.05
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$276.82
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$276.82 |
| Rate for Payer: Aetna Commercial |
$249.14
|
| Rate for Payer: ASR ASR |
$268.52
|
| Rate for Payer: ASR Commercial |
$268.52
|
| Rate for Payer: BCBS Trust/PPO |
$225.58
|
| Rate for Payer: BCN Commercial |
$214.62
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cofinity Commercial |
$260.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.46
|
| Rate for Payer: Healthscope Commercial |
$276.82
|
| Rate for Payer: Healthscope Whirlpool |
$268.52
|
| Rate for Payer: Mclaren Commercial |
$249.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.30
|
| Rate for Payer: Nomi Health Commercial |
$226.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.60
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: ASR Commercial |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.74
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: ASR Commercial |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$40.94
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.81
|
| Rate for Payer: Priority Health Narrow Network |
$35.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: ASR Commercial |
$24.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$20.47
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.90
|
| Rate for Payer: Priority Health Narrow Network |
$17.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: ASR Commercial |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.37
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$92.78 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.75
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS MAPPO |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$11.00
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.00
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$5.90
|
| Rate for Payer: Mclaren Medicare |
$11.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.55
|
| Rate for Payer: Meridian Medicaid |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PACE Medicare |
$10.45
|
| Rate for Payer: PACE SWMI |
$11.00
|
| Rate for Payer: PHP Commercial |
$12.10
|
| Rate for Payer: PHP Medicaid |
$5.90
|
| Rate for Payer: PHP Medicare Advantage |
$11.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.78
|
| Rate for Payer: Priority Health Medicare |
$11.00
|
| Rate for Payer: Priority Health Narrow Network |
$74.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.00
|
| Rate for Payer: UHC Exchange |
$17.05
|
| Rate for Payer: UHC Medicare Advantage |
$11.00
|
| Rate for Payer: UHCCP DNSP |
$11.00
|
| Rate for Payer: UHCCP Medicaid |
$5.90
|
| Rate for Payer: VA VA |
$11.00
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: ASR ASR |
$24.41
|
| Rate for Payer: ASR Commercial |
$24.41
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.61
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.58
|
| Rate for Payer: Mclaren Commercial |
$22.65
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicaid |
$1.92
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP DNSP |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$25.17
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: ASR ASR |
$24.41
|
| Rate for Payer: ASR Commercial |
$24.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.51
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Mclaren Commercial |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.15
|
|
|
HC PHENOBARB LVL
|
Facility
|
OP
|
$100.57
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna Commercial |
$90.51
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$97.55
|
| Rate for Payer: ASR Commercial |
$97.55
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$82.36
|
| Rate for Payer: BCN Commercial |
$77.97
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cofinity Commercial |
$94.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$100.57
|
| Rate for Payer: Healthscope Whirlpool |
$97.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$90.51
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.48
|
| Rate for Payer: Nomi Health Commercial |
$82.47
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.10
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$68.08
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$23.72
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP DNSP |
$15.30
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC PHENOBARB LVL
|
Facility
|
IP
|
$100.57
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna Commercial |
$90.51
|
| Rate for Payer: ASR ASR |
$97.55
|
| Rate for Payer: ASR Commercial |
$97.55
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCN Commercial |
$77.97
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cofinity Commercial |
$94.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$100.57
|
| Rate for Payer: Healthscope Whirlpool |
$97.55
|
| Rate for Payer: Mclaren Commercial |
$90.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.48
|
| Rate for Payer: Nomi Health Commercial |
$82.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.50
|
|
