|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$846.32 |
| Max. Negotiated Rate |
$1,128.42 |
| Rate for Payer: Aetna Commercial |
$1,015.58
|
| Rate for Payer: ASR ASR |
$1,094.57
|
| Rate for Payer: BCBS Trust/PPO |
$926.66
|
| Rate for Payer: BCN Commercial |
$926.66
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cofinity Commercial |
$1,060.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$902.74
|
| Rate for Payer: Healthscope Commercial |
$1,094.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,128.42
|
| Rate for Payer: Mclaren Commercial |
$1,015.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.16
|
| Rate for Payer: Nomi Health Commercial |
$925.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.01
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$1,128.42 |
| Rate for Payer: Aetna Commercial |
$1,015.58
|
| Rate for Payer: Aetna Medicare |
$180.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: ASR ASR |
$1,094.57
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$930.38
|
| Rate for Payer: BCN Commercial |
$930.38
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cofinity Commercial |
$1,060.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$902.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$1,094.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,128.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$180.34
|
| Rate for Payer: Mclaren Commercial |
$1,015.58
|
| Rate for Payer: Mclaren Medicaid |
$180.34
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$99.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.16
|
| Rate for Payer: Nomi Health Commercial |
$925.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.32
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$198.37
|
| Rate for Payer: PHP Medicaid |
$96.66
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.44
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health Narrow Network |
$277.96
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$279.53
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP DNSP |
$180.34
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| 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 |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: ASR ASR |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.82
|
| Rate for Payer: Healthscope Whirlpool |
$6.00
|
| Rate for Payer: Mclaren Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.28
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: ASR ASR |
$5.82
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.95
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.82
|
| Rate for Payer: Healthscope Whirlpool |
$6.00
|
| Rate for Payer: Mclaren Commercial |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.26
|
| Rate for Payer: Priority Health Narrow Network |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.28
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: ASR ASR |
$9.08
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$7.72
|
| Rate for Payer: BCN Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$9.08
|
| Rate for Payer: Healthscope Whirlpool |
$9.36
|
| Rate for Payer: Mclaren Commercial |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Nomi Health Commercial |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.20
|
| Rate for Payer: Priority Health Narrow Network |
$6.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.24
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: ASR ASR |
$9.08
|
| Rate for Payer: BCBS Trust/PPO |
$7.69
|
| Rate for Payer: BCN Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$9.08
|
| Rate for Payer: Healthscope Whirlpool |
$9.36
|
| Rate for Payer: Mclaren Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Nomi Health Commercial |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.24
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$335.56 |
| Max. Negotiated Rate |
$447.42 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Trust/PPO |
$367.42
|
| Rate for Payer: BCN Commercial |
$367.42
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$447.42 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$368.90
|
| Rate for Payer: BCN Commercial |
$368.90
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.10
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$248.88
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$899.63
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$899.63 |
| Rate for Payer: Aetna Commercial |
$809.67
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$872.64
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$741.74
|
| Rate for Payer: BCN Commercial |
$741.74
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cofinity Commercial |
$845.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$872.64
|
| Rate for Payer: Healthscope Whirlpool |
$899.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$809.67
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.69
|
| Rate for Payer: Nomi Health Commercial |
$737.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.72
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.10
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$248.88
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$791.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$899.63
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$674.72 |
| Max. Negotiated Rate |
$899.63 |
| Rate for Payer: Aetna Commercial |
$809.67
|
| Rate for Payer: ASR ASR |
$872.64
|
| Rate for Payer: BCBS Trust/PPO |
$738.78
|
| Rate for Payer: BCN Commercial |
$738.78
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cofinity Commercial |
$845.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.70
|
| Rate for Payer: Healthscope Commercial |
$872.64
|
| Rate for Payer: Healthscope Whirlpool |
$899.63
|
| Rate for Payer: Mclaren Commercial |
$809.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.69
|
| Rate for Payer: Nomi Health Commercial |
$737.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$791.67
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.05 |
| Max. Negotiated Rate |
$474.35 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Medicare |
$306.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.54
|
| Rate for Payer: ASR ASR |
$417.10
|
| Rate for Payer: BCBS Complete |
$168.07
|
| Rate for Payer: BCBS MAPPO |
$306.03
|
| Rate for Payer: BCBS Trust/PPO |
$354.54
|
| Rate for Payer: BCN Commercial |
$354.54
|
| Rate for Payer: BCN Medicare Advantage |
$306.03
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.03
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Healthscope Whirlpool |
$430.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$306.03
|
| Rate for Payer: Mclaren Commercial |
$387.00
|
| Rate for Payer: Mclaren Medicaid |
$306.03
|
| Rate for Payer: Mclaren Medicare |
$306.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.33
|
| Rate for Payer: Meridian Medicaid |
$168.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.50
|
| Rate for Payer: Nomi Health Commercial |
$352.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.50
|
| Rate for Payer: PACE Medicare |
$290.73
|
| Rate for Payer: PACE SWMI |
$306.03
|
| Rate for Payer: PHP Commercial |
$336.63
|
| Rate for Payer: PHP Medicaid |
$164.03
|
| Rate for Payer: PHP Medicare Advantage |
$306.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$376.77
|
| Rate for Payer: Priority Health Medicare |
$306.03
|
| Rate for Payer: Priority Health Narrow Network |
$301.43
|
| Rate for Payer: Railroad Medicare Medicare |
$306.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$306.03
|
| Rate for Payer: UHC Exchange |
$474.35
|
| Rate for Payer: UHC Medicaid |
$160.05
|
| Rate for Payer: UHCCP DNSP |
$306.03
|
| Rate for Payer: UHCCP Medicaid |
$160.05
|
| Rate for Payer: VA VA |
$306.03
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: ASR ASR |
$417.10
|
| Rate for Payer: BCBS Trust/PPO |
$353.12
|
| Rate for Payer: BCN Commercial |
$353.12
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Healthscope Whirlpool |
$430.00
|
| Rate for Payer: Mclaren Commercial |
$387.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.50
|
| Rate for Payer: Nomi Health Commercial |
$352.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.40
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$158.12
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$158.12 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$153.38
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$130.37
|
| Rate for Payer: BCN Commercial |
$130.37
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cofinity Commercial |
$148.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$153.38
|
| Rate for Payer: Healthscope Whirlpool |
$158.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$142.31
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.40
|
| Rate for Payer: Nomi Health Commercial |
$129.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.59
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.54
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$110.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$158.12
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$158.12 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: ASR ASR |
$153.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.85
|
| Rate for Payer: BCN Commercial |
$129.85
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cofinity Commercial |
$148.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.50
|
| Rate for Payer: Healthscope Commercial |
$153.38
|
| Rate for Payer: Healthscope Whirlpool |
$158.12
|
| Rate for Payer: Mclaren Commercial |
$142.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.40
|
| Rate for Payer: Nomi Health Commercial |
$129.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.15
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$326.85
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$245.14 |
| Max. Negotiated Rate |
$326.85 |
| Rate for Payer: Aetna Commercial |
$294.17
|
| Rate for Payer: ASR ASR |
$317.04
|
| Rate for Payer: BCBS Trust/PPO |
$268.41
|
| Rate for Payer: BCN Commercial |
$268.41
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cofinity Commercial |
$307.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.48
|
| Rate for Payer: Healthscope Commercial |
$317.04
|
| Rate for Payer: Healthscope Whirlpool |
$326.85
|
| Rate for Payer: Mclaren Commercial |
$294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.82
|
| Rate for Payer: Nomi Health Commercial |
$268.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.63
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$326.85
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$326.85 |
| Rate for Payer: Aetna Commercial |
$294.17
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$317.04
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$269.49
|
| Rate for Payer: BCN Commercial |
$269.49
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cofinity Commercial |
$307.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$317.04
|
| Rate for Payer: Healthscope Whirlpool |
$326.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$294.17
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.82
|
| Rate for Payer: Nomi Health Commercial |
$268.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.14
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$286.39
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$229.12
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$120.14
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$44.45 |
| Max. Negotiated Rate |
$120.14 |
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: Aetna Medicare |
$44.45
|
| Rate for Payer: ASR ASR |
$116.54
|
| Rate for Payer: BCBS Complete |
$48.06
|
| Rate for Payer: BCBS Trust/PPO |
$99.06
|
| Rate for Payer: BCN Commercial |
$99.06
|
| Rate for Payer: Cash Price |
$96.11
|
| Rate for Payer: Cofinity Commercial |
$112.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.11
|
| Rate for Payer: Healthscope Commercial |
$116.54
|
| Rate for Payer: Healthscope Whirlpool |
$120.14
|
| Rate for Payer: Mclaren Commercial |
$108.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.12
|
| Rate for Payer: Nomi Health Commercial |
$98.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.27
|
| Rate for Payer: Priority Health Narrow Network |
$84.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.72
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$120.14
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.11 |
| Max. Negotiated Rate |
$120.14 |
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: ASR ASR |
$116.54
|
| Rate for Payer: BCBS Trust/PPO |
$98.66
|
| Rate for Payer: BCN Commercial |
$98.66
|
| Rate for Payer: Cash Price |
$96.11
|
| Rate for Payer: Cofinity Commercial |
$112.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.11
|
| Rate for Payer: Healthscope Commercial |
$116.54
|
| Rate for Payer: Healthscope Whirlpool |
$120.14
|
| Rate for Payer: Mclaren Commercial |
$108.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.12
|
| Rate for Payer: Nomi Health Commercial |
$98.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.72
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$607.70
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$455.77 |
| Max. Negotiated Rate |
$607.70 |
| Rate for Payer: Aetna Commercial |
$546.93
|
| Rate for Payer: ASR ASR |
$589.47
|
| Rate for Payer: BCBS Trust/PPO |
$499.04
|
| Rate for Payer: BCN Commercial |
$499.04
|
| Rate for Payer: Cash Price |
$486.16
|
| Rate for Payer: Cofinity Commercial |
$571.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.16
|
| Rate for Payer: Healthscope Commercial |
$589.47
|
| Rate for Payer: Healthscope Whirlpool |
$607.70
|
| Rate for Payer: Mclaren Commercial |
$546.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.54
|
| Rate for Payer: Nomi Health Commercial |
$498.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$534.78
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$607.70
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$224.85 |
| Max. Negotiated Rate |
$607.70 |
| Rate for Payer: Aetna Commercial |
$546.93
|
| Rate for Payer: Aetna Medicare |
$224.85
|
| Rate for Payer: ASR ASR |
$589.47
|
| Rate for Payer: BCBS Complete |
$243.08
|
| Rate for Payer: BCBS Trust/PPO |
$501.05
|
| Rate for Payer: BCN Commercial |
$501.05
|
| Rate for Payer: Cash Price |
$486.16
|
| Rate for Payer: Cofinity Commercial |
$571.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.16
|
| Rate for Payer: Healthscope Commercial |
$589.47
|
| Rate for Payer: Healthscope Whirlpool |
$607.70
|
| Rate for Payer: Mclaren Commercial |
$546.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.54
|
| Rate for Payer: Nomi Health Commercial |
$498.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$532.47
|
| Rate for Payer: Priority Health Narrow Network |
$426.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$534.78
|
|
|
HC REM MNTR PHYSIOL PARAM 16-30 DAYS
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$90.07
|
| Rate for Payer: BCN Commercial |
$90.07
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.19
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$37.19
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$40.91
|
| Rate for Payer: PHP Medicaid |
$19.93
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.90
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$57.64
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP DNSP |
$37.19
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$37.19
|
|
|
HC REM MNTR PHYSIOL PARAM 16-30 DAYS
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.71
|
| Rate for Payer: BCN Commercial |
$89.71
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$353.74
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$353.74 |
| Rate for Payer: Aetna Commercial |
$318.37
|
| Rate for Payer: Aetna Medicare |
$132.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: ASR ASR |
$343.13
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.66
|
| Rate for Payer: BCN Commercial |
$291.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$282.99
|
| Rate for Payer: Cash Price |
$282.99
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$343.13
|
| Rate for Payer: Healthscope Whirlpool |
$353.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.66
|
| Rate for Payer: Mclaren Commercial |
$318.37
|
| Rate for Payer: Mclaren Medicaid |
$132.66
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$72.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.68
|
| Rate for Payer: Nomi Health Commercial |
$290.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.31
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$145.93
|
| Rate for Payer: PHP Medicaid |
$71.11
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.23
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health Narrow Network |
$116.99
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$205.62
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP DNSP |
$132.66
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
