|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$235.86 |
| Rate for Payer: Aetna Commercial |
$212.27
|
| Rate for Payer: Aetna Medicare |
$101.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: ASR ASR |
$228.78
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$194.47
|
| Rate for Payer: BCN Commercial |
$194.47
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Commercial |
$221.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$228.78
|
| Rate for Payer: Healthscope Whirlpool |
$235.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.66
|
| Rate for Payer: Mclaren Commercial |
$212.27
|
| Rate for Payer: Mclaren Medicaid |
$101.66
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$193.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$111.83
|
| Rate for Payer: PHP Medicaid |
$54.49
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$206.66
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health Narrow Network |
$165.34
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$157.57
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP DNSP |
$101.66
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: VA VA |
$101.66
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$235.86 |
| Rate for Payer: Aetna Commercial |
$212.27
|
| Rate for Payer: ASR ASR |
$228.78
|
| Rate for Payer: BCBS Trust/PPO |
$193.69
|
| Rate for Payer: BCN Commercial |
$193.69
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Commercial |
$221.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Healthscope Commercial |
$228.78
|
| Rate for Payer: Healthscope Whirlpool |
$235.86
|
| Rate for Payer: Mclaren Commercial |
$212.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$193.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.56
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
OP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Aetna Commercial |
$228.74
|
| Rate for Payer: Aetna Medicare |
$101.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: ASR ASR |
$246.53
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$209.55
|
| Rate for Payer: BCN Commercial |
$209.55
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$246.53
|
| Rate for Payer: Healthscope Whirlpool |
$254.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.66
|
| Rate for Payer: Mclaren Commercial |
$228.74
|
| Rate for Payer: Mclaren Medicaid |
$101.66
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$208.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$111.83
|
| Rate for Payer: PHP Medicaid |
$54.49
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$222.69
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health Narrow Network |
$178.16
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$157.57
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP DNSP |
$101.66
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: VA VA |
$101.66
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
IP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Aetna Commercial |
$228.74
|
| Rate for Payer: ASR ASR |
$246.53
|
| Rate for Payer: BCBS Trust/PPO |
$208.71
|
| Rate for Payer: BCN Commercial |
$208.71
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Healthscope Commercial |
$246.53
|
| Rate for Payer: Healthscope Whirlpool |
$254.15
|
| Rate for Payer: Mclaren Commercial |
$228.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$208.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.65
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
IP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$720.57 |
| Max. Negotiated Rate |
$960.76 |
| Rate for Payer: Aetna Commercial |
$864.68
|
| Rate for Payer: ASR ASR |
$931.94
|
| Rate for Payer: BCBS Trust/PPO |
$788.98
|
| Rate for Payer: BCN Commercial |
$788.98
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Commercial |
$903.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Healthscope Commercial |
$931.94
|
| Rate for Payer: Healthscope Whirlpool |
$960.76
|
| Rate for Payer: Mclaren Commercial |
$864.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$787.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$845.47
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
OP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$960.76 |
| Rate for Payer: Aetna Commercial |
$864.68
|
| Rate for Payer: Aetna Medicare |
$384.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: ASR ASR |
$931.94
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$792.15
|
| Rate for Payer: BCN Commercial |
$792.15
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Commercial |
$903.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$931.94
|
| Rate for Payer: Healthscope Whirlpool |
$960.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$384.31
|
| Rate for Payer: Mclaren Commercial |
$864.68
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$211.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$787.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$422.74
|
| Rate for Payer: PHP Medicaid |
$205.99
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$841.82
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health Narrow Network |
$673.49
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$845.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$595.68
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP DNSP |
$384.31
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,376.40 |
| Rate for Payer: Aetna Commercial |
$1,238.76
|
| Rate for Payer: Aetna Medicare |
$550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: ASR ASR |
$1,335.11
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.84
|
| Rate for Payer: BCN Commercial |
$1,134.84
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,293.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$1,335.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$550.56
|
| Rate for Payer: Mclaren Commercial |
$1,238.76
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$302.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,128.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$605.62
|
| Rate for Payer: PHP Medicaid |
$295.10
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,206.00
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health Narrow Network |
$964.86
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$853.37
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP DNSP |
$550.56
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$550.56
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,032.30 |
| Max. Negotiated Rate |
$1,376.40 |
| Rate for Payer: Aetna Commercial |
$1,238.76
|
| Rate for Payer: ASR ASR |
$1,335.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.30
|
| Rate for Payer: BCN Commercial |
$1,130.30
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,293.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,335.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.40
|
| Rate for Payer: Mclaren Commercial |
$1,238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,128.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.23
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
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 ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
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 RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$15,687.60 |
| Rate for Payer: Aetna Commercial |
$14,118.84
|
| Rate for Payer: Aetna Medicare |
$5,544.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: ASR ASR |
$15,216.97
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$12,934.43
|
| Rate for Payer: BCN Commercial |
$12,934.43
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Commercial |
$14,746.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$15,216.97
|
| Rate for Payer: Healthscope Whirlpool |
$15,687.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,544.48
|
| Rate for Payer: Mclaren Commercial |
$14,118.84
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$3,045.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Nomi Health Commercial |
$12,863.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,098.93
|
| Rate for Payer: PHP Medicaid |
$2,971.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,745.48
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$10,997.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,805.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$8,593.94
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP DNSP |
$5,544.48
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,765.70 |
| Max. Negotiated Rate |
$15,687.60 |
| Rate for Payer: Aetna Commercial |
$14,118.84
|
| Rate for Payer: ASR ASR |
$15,216.97
|
| Rate for Payer: BCBS Trust/PPO |
$12,882.66
|
| Rate for Payer: BCN Commercial |
$12,882.66
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Commercial |
$14,746.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Healthscope Commercial |
$15,216.97
|
| Rate for Payer: Healthscope Whirlpool |
$15,687.60
|
| Rate for Payer: Mclaren Commercial |
$14,118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Nomi Health Commercial |
$12,863.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,805.09
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$44.78 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicaid |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.25
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$18.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicaid |
$2.30
|
| Rate for Payer: UHCCP DNSP |
$4.40
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$65.36
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$121.54 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.20
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$70.20
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$77.22
|
| Rate for Payer: PHP Medicaid |
$37.63
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.54
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health Narrow Network |
$97.23
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$108.81
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP DNSP |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$996.44 |
| Max. Negotiated Rate |
$1,328.59 |
| Rate for Payer: Aetna Commercial |
$1,195.73
|
| Rate for Payer: ASR ASR |
$1,288.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.04
|
| Rate for Payer: BCN Commercial |
$1,091.04
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Commercial |
$1,248.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.59
|
| Rate for Payer: Mclaren Commercial |
$1,195.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Nomi Health Commercial |
$1,089.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.16
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$491.58 |
| Max. Negotiated Rate |
$1,328.59 |
| Rate for Payer: Aetna Commercial |
$1,195.73
|
| Rate for Payer: Aetna Medicare |
$491.58
|
| Rate for Payer: ASR ASR |
$1,288.73
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.42
|
| Rate for Payer: BCN Commercial |
$1,095.42
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Commercial |
$1,248.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.59
|
| Rate for Payer: Mclaren Commercial |
$1,195.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Nomi Health Commercial |
$1,089.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$678.37
|
| Rate for Payer: Priority Health Narrow Network |
$542.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.16
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$996.44 |
| Max. Negotiated Rate |
$1,328.59 |
| Rate for Payer: Aetna Commercial |
$1,195.73
|
| Rate for Payer: ASR ASR |
$1,288.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.04
|
| Rate for Payer: BCN Commercial |
$1,091.04
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Commercial |
$1,248.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.59
|
| Rate for Payer: Mclaren Commercial |
$1,195.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Nomi Health Commercial |
$1,089.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.16
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$491.58 |
| Max. Negotiated Rate |
$1,328.59 |
| Rate for Payer: Aetna Commercial |
$1,195.73
|
| Rate for Payer: Aetna Medicare |
$491.58
|
| Rate for Payer: ASR ASR |
$1,288.73
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.42
|
| Rate for Payer: BCN Commercial |
$1,095.42
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Commercial |
$1,248.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.59
|
| Rate for Payer: Mclaren Commercial |
$1,195.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Nomi Health Commercial |
$1,089.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$678.37
|
| Rate for Payer: Priority Health Narrow Network |
$542.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.16
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: ASR ASR |
$69.94
|
| Rate for Payer: BCBS Trust/PPO |
$59.21
|
| Rate for Payer: BCN Commercial |
$59.21
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Commercial |
$67.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$69.94
|
| Rate for Payer: Healthscope Whirlpool |
$72.10
|
| Rate for Payer: Mclaren Commercial |
$64.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Nomi Health Commercial |
$59.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.45
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: Aetna Medicare |
$26.68
|
| Rate for Payer: ASR ASR |
$69.94
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$59.45
|
| Rate for Payer: BCN Commercial |
$59.45
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Commercial |
$67.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$69.94
|
| Rate for Payer: Healthscope Whirlpool |
$72.10
|
| Rate for Payer: Mclaren Commercial |
$64.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Nomi Health Commercial |
$59.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.17
|
| Rate for Payer: Priority Health Narrow Network |
$50.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.45
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
