|
HC WALNUT TREE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| 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 |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WALNUT TREE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC WASHED RED BLOOD CELLS
|
Facility
|
OP
|
$813.45
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
39000073
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Aetna Commercial |
$732.10
|
| Rate for Payer: Aetna Medicare |
$370.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.10
|
| Rate for Payer: ASR ASR |
$789.05
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$370.48
|
| Rate for Payer: BCBS Trust/PPO |
$630.67
|
| Rate for Payer: BCN Commercial |
$630.67
|
| Rate for Payer: BCN Medicare Advantage |
$370.48
|
| Rate for Payer: Cash Price |
$650.76
|
| Rate for Payer: Cash Price |
$650.76
|
| Rate for Payer: Cofinity Commercial |
$764.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.48
|
| Rate for Payer: Healthscope Commercial |
$813.45
|
| Rate for Payer: Healthscope Whirlpool |
$789.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$370.48
|
| Rate for Payer: Mclaren Commercial |
$732.10
|
| Rate for Payer: Mclaren Medicaid |
$202.65
|
| Rate for Payer: Mclaren Medicare |
$370.48
|
| Rate for Payer: Meridian Medicaid |
$212.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$389.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$691.43
|
| Rate for Payer: PACE Medicare |
$351.96
|
| Rate for Payer: PACE SWMI |
$370.48
|
| Rate for Payer: PHP Commercial |
$407.53
|
| Rate for Payer: PHP Medicaid |
$202.65
|
| Rate for Payer: PHP Medicare Advantage |
$370.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.98
|
| Rate for Payer: Priority Health Medicare |
$370.48
|
| Rate for Payer: Priority Health Narrow Network |
$429.58
|
| Rate for Payer: Railroad Medicare Medicare |
$370.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.84
|
| Rate for Payer: UHC Medicare Advantage |
$381.59
|
| Rate for Payer: VA VA |
$370.48
|
|
|
HC WASHED RED BLOOD CELLS
|
Facility
|
IP
|
$813.45
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
39000073
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$569.42 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Aetna Commercial |
$732.10
|
| Rate for Payer: ASR ASR |
$789.05
|
| Rate for Payer: BCBS Trust/PPO |
$630.67
|
| Rate for Payer: BCN Commercial |
$630.67
|
| Rate for Payer: Cash Price |
$650.76
|
| Rate for Payer: Cofinity Commercial |
$764.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.76
|
| Rate for Payer: Healthscope Commercial |
$813.45
|
| Rate for Payer: Healthscope Whirlpool |
$789.05
|
| Rate for Payer: Mclaren Commercial |
$732.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$691.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.84
|
|
|
HC WATCH PAT
|
Facility
|
IP
|
$667.46
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$667.46 |
| Rate for Payer: Aetna Commercial |
$600.71
|
| Rate for Payer: ASR ASR |
$647.44
|
| Rate for Payer: BCBS Trust/PPO |
$517.48
|
| Rate for Payer: BCN Commercial |
$517.48
|
| Rate for Payer: Cash Price |
$533.97
|
| Rate for Payer: Cofinity Commercial |
$627.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.97
|
| Rate for Payer: Healthscope Commercial |
$667.46
|
| Rate for Payer: Healthscope Whirlpool |
$647.44
|
| Rate for Payer: Mclaren Commercial |
$600.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$587.36
|
|
|
HC WATCH PAT
|
Facility
|
OP
|
$667.46
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$667.46 |
| Rate for Payer: Aetna Commercial |
$600.71
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$647.44
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$517.48
|
| Rate for Payer: BCN Commercial |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$533.97
|
| Rate for Payer: Cash Price |
$533.97
|
| Rate for Payer: Cofinity Commercial |
$627.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$667.46
|
| Rate for Payer: Healthscope Whirlpool |
$647.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$600.71
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.34
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$607.39
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$473.90
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$587.36
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC WBC BUFFY COAT
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
30500004
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.34
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Complete |
$2.91
|
| Rate for Payer: BCBS MAPPO |
$5.07
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: BCN Medicare Advantage |
$5.07
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.07
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| Rate for Payer: Mclaren Medicare |
$5.07
|
| Rate for Payer: Meridian Medicaid |
$2.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$4.82
|
| Rate for Payer: PACE SWMI |
$5.07
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: PHP Medicaid |
$2.77
|
| Rate for Payer: PHP Medicare Advantage |
$5.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.31
|
| Rate for Payer: Priority Health Medicare |
$5.07
|
| Rate for Payer: Priority Health Narrow Network |
$32.23
|
| Rate for Payer: Railroad Medicare Medicare |
$5.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: VA VA |
$5.07
|
|
|
HC WBC BUFFY COAT
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
30500004
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
|
|
HC WBC COUNT
|
Facility
|
IP
|
$26.52
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
30500011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: ASR ASR |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$26.52
|
| Rate for Payer: Healthscope Whirlpool |
$25.72
|
| Rate for Payer: Mclaren Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.34
|
|
|
HC WBC COUNT
|
Facility
|
OP
|
$26.52
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
30500011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.18
|
| Rate for Payer: ASR ASR |
$25.72
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: BCN Medicare Advantage |
$2.54
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$26.52
|
| Rate for Payer: Healthscope Whirlpool |
$25.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.54
|
| Rate for Payer: Mclaren Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Mclaren Medicare |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.54
|
| Rate for Payer: PACE Medicare |
$2.41
|
| Rate for Payer: PACE SWMI |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.79
|
| Rate for Payer: PHP Medicaid |
$1.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health Medicare |
$2.54
|
| Rate for Payer: Priority Health Narrow Network |
$16.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.34
|
| Rate for Payer: UHC Medicare Advantage |
$2.62
|
| Rate for Payer: VA VA |
$2.54
|
|
|
HC WC EVAL JOB SITE ANALYSIS EACH 30 MIN
|
Facility
|
IP
|
$215.90
|
|
| Hospital Charge Code |
42000045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: ASR ASR |
$209.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.39
|
| Rate for Payer: BCN Commercial |
$167.39
|
| Rate for Payer: Cash Price |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.72
|
| Rate for Payer: Healthscope Commercial |
$215.90
|
| Rate for Payer: Healthscope Whirlpool |
$209.42
|
| Rate for Payer: Mclaren Commercial |
$194.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.99
|
|
|
HC WC EVAL JOB SITE ANALYSIS EACH 30 MIN
|
Facility
|
OP
|
$215.90
|
|
| Hospital Charge Code |
42000045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.36 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: ASR ASR |
$209.42
|
| Rate for Payer: BCBS Complete |
$86.36
|
| Rate for Payer: BCBS Trust/PPO |
$167.39
|
| Rate for Payer: BCN Commercial |
$167.39
|
| Rate for Payer: Cash Price |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.72
|
| Rate for Payer: Healthscope Commercial |
$215.90
|
| Rate for Payer: Healthscope Whirlpool |
$209.42
|
| Rate for Payer: Mclaren Commercial |
$194.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.47
|
| Rate for Payer: Priority Health Narrow Network |
$153.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.99
|
|
|
HC WC EVAL JOB SITE ANALYSIS FIRST 60 MIN
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
42000044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: ASR ASR |
$284.21
|
| Rate for Payer: BCBS Trust/PPO |
$227.16
|
| Rate for Payer: BCN Commercial |
$227.16
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Healthscope Commercial |
$293.00
|
| Rate for Payer: Healthscope Whirlpool |
$284.21
|
| Rate for Payer: Mclaren Commercial |
$263.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.84
|
|
|
HC WC EVAL JOB SITE ANALYSIS FIRST 60 MIN
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
42000044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: ASR ASR |
$284.21
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS Trust/PPO |
$227.16
|
| Rate for Payer: BCN Commercial |
$227.16
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Healthscope Commercial |
$293.00
|
| Rate for Payer: Healthscope Whirlpool |
$284.21
|
| Rate for Payer: Mclaren Commercial |
$263.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.63
|
| Rate for Payer: Priority Health Narrow Network |
$208.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.84
|
|
|
HC WC UNLISTED BREAST PROCEDURE
|
Facility
|
IP
|
$2,181.48
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.04 |
| Max. Negotiated Rate |
$2,181.48 |
| Rate for Payer: Aetna Commercial |
$1,963.33
|
| Rate for Payer: ASR ASR |
$2,116.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.30
|
| Rate for Payer: BCN Commercial |
$1,691.30
|
| Rate for Payer: Cash Price |
$1,745.18
|
| Rate for Payer: Cofinity Commercial |
$2,050.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.18
|
| Rate for Payer: Healthscope Commercial |
$2,181.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,116.04
|
| Rate for Payer: Mclaren Commercial |
$1,963.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,854.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,919.70
|
|
|
HC WC UNLISTED BREAST PROCEDURE
|
Facility
|
OP
|
$2,181.48
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.04 |
| Max. Negotiated Rate |
$4,235.21 |
| Rate for Payer: Aetna Commercial |
$1,963.33
|
| Rate for Payer: Aetna Medicare |
$3,388.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: ASR ASR |
$2,116.04
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.30
|
| Rate for Payer: BCN Commercial |
$1,691.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$1,745.18
|
| Rate for Payer: Cash Price |
$1,745.18
|
| Rate for Payer: Cofinity Commercial |
$2,050.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$2,181.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,116.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,388.17
|
| Rate for Payer: Mclaren Commercial |
$1,963.33
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,854.26
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$3,726.99
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,985.15
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,919.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
HC WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$564.41
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$564.41 |
| Rate for Payer: Aetna Commercial |
$507.97
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$547.48
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$437.59
|
| Rate for Payer: BCN Commercial |
$437.59
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$451.53
|
| Rate for Payer: Cash Price |
$451.53
|
| Rate for Payer: Cofinity Commercial |
$530.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$564.41
|
| Rate for Payer: Healthscope Whirlpool |
$547.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$507.97
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$479.75
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.20
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$196.96
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.68
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$564.41
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.09 |
| Max. Negotiated Rate |
$564.41 |
| Rate for Payer: Aetna Commercial |
$507.97
|
| Rate for Payer: ASR ASR |
$547.48
|
| Rate for Payer: BCBS Trust/PPO |
$437.59
|
| Rate for Payer: BCN Commercial |
$437.59
|
| Rate for Payer: Cash Price |
$451.53
|
| Rate for Payer: Cofinity Commercial |
$530.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.53
|
| Rate for Payer: Healthscope Commercial |
$564.41
|
| Rate for Payer: Healthscope Whirlpool |
$547.48
|
| Rate for Payer: Mclaren Commercial |
$507.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$479.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.68
|
|
|
HC WEST NILE VIRUS AB IGG & IGM
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200329
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.77
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$22.45
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC WEST NILE VIRUS AB IGG & IGM
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200329
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC WEST NILE VIRUS AB IGG & IGM CSF
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.91
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$31.14
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC WEST NILE VIRUS AB IGG & IGM CSF
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC WEST NILE VIRUS CMPT
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
30200331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.77
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$22.45
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC WEST NILE VIRUS CMPT
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
30200331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC WEST NILE VIRUS CSF CMPT
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
30200332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
