|
HC RED CEDAR IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$302.94 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: ASR ASR |
$293.85
|
| Rate for Payer: ASR Commercial |
$293.85
|
| Rate for Payer: BCBS Trust/PPO |
$246.87
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$284.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Healthscope Whirlpool |
$293.85
|
| Rate for Payer: Mclaren Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.59
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
OP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.27 |
| Max. Negotiated Rate |
$574.03 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: ASR ASR |
$293.85
|
| Rate for Payer: ASR Commercial |
$293.85
|
| Rate for Payer: BCBS Complete |
$104.23
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$248.08
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$284.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Healthscope Whirlpool |
$293.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$185.20
|
| Rate for Payer: Mclaren Commercial |
$272.65
|
| Rate for Payer: Mclaren Medicaid |
$99.27
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: Meridian Medicaid |
$104.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$203.72
|
| Rate for Payer: PHP Medicaid |
$99.27
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$574.03
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health Narrow Network |
$459.22
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Exchange |
$287.06
|
| Rate for Payer: UHC Medicare Advantage |
$185.20
|
| Rate for Payer: UHCCP DNSP |
$185.20
|
| Rate for Payer: UHCCP Medicaid |
$99.27
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.76 |
| Max. Negotiated Rate |
$218.10 |
| Rate for Payer: Aetna Commercial |
$196.29
|
| Rate for Payer: ASR ASR |
$211.56
|
| Rate for Payer: ASR Commercial |
$211.56
|
| Rate for Payer: BCBS Trust/PPO |
$177.73
|
| Rate for Payer: BCN Commercial |
$169.09
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$205.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Healthscope Commercial |
$218.10
|
| Rate for Payer: Healthscope Whirlpool |
$211.56
|
| Rate for Payer: Mclaren Commercial |
$196.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: Nomi Health Commercial |
$178.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.93
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$218.10 |
| Rate for Payer: Aetna Commercial |
$196.29
|
| Rate for Payer: Aetna Medicare |
$109.05
|
| Rate for Payer: ASR ASR |
$211.56
|
| Rate for Payer: ASR Commercial |
$211.56
|
| Rate for Payer: BCBS Complete |
$87.24
|
| Rate for Payer: BCBS Trust/PPO |
$178.60
|
| Rate for Payer: BCN Commercial |
$169.09
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$205.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Healthscope Commercial |
$218.10
|
| Rate for Payer: Healthscope Whirlpool |
$211.56
|
| Rate for Payer: Mclaren Commercial |
$196.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: Nomi Health Commercial |
$178.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.10
|
| Rate for Payer: Priority Health Narrow Network |
$152.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.93
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$719.09 |
| Max. Negotiated Rate |
$1,106.29 |
| Rate for Payer: Aetna Commercial |
$995.66
|
| Rate for Payer: ASR ASR |
$1,073.10
|
| Rate for Payer: ASR Commercial |
$1,073.10
|
| Rate for Payer: BCBS Trust/PPO |
$901.52
|
| Rate for Payer: BCN Commercial |
$857.71
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$1,039.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Healthscope Commercial |
$1,106.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.10
|
| Rate for Payer: Mclaren Commercial |
$995.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: Nomi Health Commercial |
$907.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$973.54
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$1,106.29 |
| Rate for Payer: Aetna Commercial |
$995.66
|
| Rate for Payer: Aetna Medicare |
$178.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.90
|
| Rate for Payer: ASR ASR |
$1,073.10
|
| Rate for Payer: ASR Commercial |
$1,073.10
|
| Rate for Payer: BCBS Complete |
$100.36
|
| Rate for Payer: BCBS MAPPO |
$178.32
|
| Rate for Payer: BCBS Trust/PPO |
$905.94
|
| Rate for Payer: BCN Commercial |
$857.71
|
| Rate for Payer: BCN Medicare Advantage |
$178.32
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$1,039.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.32
|
| Rate for Payer: Healthscope Commercial |
$1,106.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$178.32
|
| Rate for Payer: Mclaren Commercial |
$995.66
|
| Rate for Payer: Mclaren Medicaid |
$95.58
|
| Rate for Payer: Mclaren Medicare |
$178.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.24
|
| Rate for Payer: Meridian Medicaid |
$100.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: Nomi Health Commercial |
$907.16
|
| Rate for Payer: PACE Medicare |
$169.40
|
| Rate for Payer: PACE SWMI |
$178.32
|
| Rate for Payer: PHP Commercial |
$196.15
|
| Rate for Payer: PHP Medicaid |
$95.58
|
| Rate for Payer: PHP Medicare Advantage |
$178.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.14
|
| Rate for Payer: Priority Health Medicare |
$178.32
|
| Rate for Payer: Priority Health Narrow Network |
$252.11
|
| Rate for Payer: Railroad Medicare Medicare |
$178.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$973.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.32
|
| Rate for Payer: UHC Exchange |
$276.40
|
| Rate for Payer: UHC Medicare Advantage |
$178.32
|
| Rate for Payer: UHCCP DNSP |
$178.32
|
| Rate for Payer: UHCCP Medicaid |
$95.58
|
| Rate for Payer: VA VA |
$178.32
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: ASR ASR |
$8.90
|
| Rate for Payer: ASR Commercial |
$8.90
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$7.52
|
| Rate for Payer: BCN Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.04
|
| Rate for Payer: Priority Health Narrow Network |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.08
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: ASR ASR |
$8.90
|
| Rate for Payer: ASR Commercial |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.08
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$438.65 |
| Rate for Payer: Aetna Commercial |
$394.78
|
| Rate for Payer: ASR ASR |
$425.49
|
| Rate for Payer: ASR Commercial |
$425.49
|
| Rate for Payer: BCBS Trust/PPO |
$357.46
|
| Rate for Payer: BCN Commercial |
$340.09
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$412.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$438.65
|
| Rate for Payer: Healthscope Whirlpool |
$425.49
|
| Rate for Payer: Mclaren Commercial |
$394.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.01
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$438.65 |
| Rate for Payer: Aetna Commercial |
$394.78
|
| Rate for Payer: Aetna Medicare |
$206.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: ASR ASR |
$425.49
|
| Rate for Payer: ASR Commercial |
$425.49
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$359.21
|
| Rate for Payer: BCN Commercial |
$340.09
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$412.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$438.65
|
| Rate for Payer: Healthscope Whirlpool |
$425.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$206.43
|
| Rate for Payer: Mclaren Commercial |
$394.78
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: PHP Medicaid |
$110.65
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$225.74
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$319.97
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP DNSP |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: VA VA |
$206.43
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$881.99 |
| Rate for Payer: Aetna Commercial |
$793.79
|
| Rate for Payer: Aetna Medicare |
$206.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: ASR ASR |
$855.53
|
| Rate for Payer: ASR Commercial |
$855.53
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$722.26
|
| Rate for Payer: BCN Commercial |
$683.81
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$829.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$881.99
|
| Rate for Payer: Healthscope Whirlpool |
$855.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$206.43
|
| Rate for Payer: Mclaren Commercial |
$793.79
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: Nomi Health Commercial |
$723.23
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: PHP Medicaid |
$110.65
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$225.74
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$319.97
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP DNSP |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: VA VA |
$206.43
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$573.29 |
| Max. Negotiated Rate |
$881.99 |
| Rate for Payer: Aetna Commercial |
$793.79
|
| Rate for Payer: ASR ASR |
$855.53
|
| Rate for Payer: ASR Commercial |
$855.53
|
| Rate for Payer: BCBS Trust/PPO |
$718.73
|
| Rate for Payer: BCN Commercial |
$683.81
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$829.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$881.99
|
| Rate for Payer: Healthscope Whirlpool |
$855.53
|
| Rate for Payer: Mclaren Commercial |
$793.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: Nomi Health Commercial |
$723.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.15
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$455.47 |
| Rate for Payer: Aetna Commercial |
$379.41
|
| Rate for Payer: Aetna Medicare |
$293.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$367.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$367.31
|
| Rate for Payer: ASR ASR |
$408.92
|
| Rate for Payer: ASR Commercial |
$408.92
|
| Rate for Payer: BCBS Complete |
$165.38
|
| Rate for Payer: BCBS MAPPO |
$293.85
|
| Rate for Payer: BCBS Trust/PPO |
$345.22
|
| Rate for Payer: BCN Commercial |
$326.84
|
| Rate for Payer: BCN Medicare Advantage |
$293.85
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$396.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.85
|
| Rate for Payer: Healthscope Commercial |
$421.57
|
| Rate for Payer: Healthscope Whirlpool |
$408.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$293.85
|
| Rate for Payer: Mclaren Commercial |
$379.41
|
| Rate for Payer: Mclaren Medicaid |
$157.50
|
| Rate for Payer: Mclaren Medicare |
$293.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.54
|
| Rate for Payer: Meridian Medicaid |
$165.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: Nomi Health Commercial |
$345.69
|
| Rate for Payer: PACE Medicare |
$279.16
|
| Rate for Payer: PACE SWMI |
$293.85
|
| Rate for Payer: PHP Commercial |
$323.24
|
| Rate for Payer: PHP Medicaid |
$157.50
|
| Rate for Payer: PHP Medicare Advantage |
$293.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.38
|
| Rate for Payer: Priority Health Medicare |
$293.85
|
| Rate for Payer: Priority Health Narrow Network |
$295.52
|
| Rate for Payer: Railroad Medicare Medicare |
$293.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.85
|
| Rate for Payer: UHC Exchange |
$455.47
|
| Rate for Payer: UHC Medicare Advantage |
$293.85
|
| Rate for Payer: UHCCP DNSP |
$293.85
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: VA VA |
$293.85
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.02 |
| Max. Negotiated Rate |
$421.57 |
| Rate for Payer: Aetna Commercial |
$379.41
|
| Rate for Payer: ASR ASR |
$408.92
|
| Rate for Payer: ASR Commercial |
$408.92
|
| Rate for Payer: BCBS Trust/PPO |
$343.54
|
| Rate for Payer: BCN Commercial |
$326.84
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$396.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Healthscope Commercial |
$421.57
|
| Rate for Payer: Healthscope Whirlpool |
$408.92
|
| Rate for Payer: Mclaren Commercial |
$379.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: Nomi Health Commercial |
$345.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.98
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$155.02 |
| Rate for Payer: Aetna Commercial |
$139.52
|
| 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 |
$150.37
|
| Rate for Payer: ASR Commercial |
$150.37
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$126.95
|
| Rate for Payer: BCN Commercial |
$120.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$145.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$155.02
|
| Rate for Payer: Healthscope Whirlpool |
$150.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$139.52
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: Nomi Health Commercial |
$127.12
|
| 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 |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.83
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$108.67
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$155.02 |
| Rate for Payer: Aetna Commercial |
$139.52
|
| Rate for Payer: ASR ASR |
$150.37
|
| Rate for Payer: ASR Commercial |
$150.37
|
| Rate for Payer: BCBS Trust/PPO |
$126.33
|
| Rate for Payer: BCN Commercial |
$120.19
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$145.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Healthscope Commercial |
$155.02
|
| Rate for Payer: Healthscope Whirlpool |
$150.37
|
| Rate for Payer: Mclaren Commercial |
$139.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: Nomi Health Commercial |
$127.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.42
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$208.29 |
| Max. Negotiated Rate |
$320.44 |
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: ASR ASR |
$310.83
|
| Rate for Payer: ASR Commercial |
$310.83
|
| Rate for Payer: BCBS Trust/PPO |
$261.13
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$301.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Healthscope Commercial |
$320.44
|
| Rate for Payer: Healthscope Whirlpool |
$310.83
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: Nomi Health Commercial |
$262.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.99
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$320.44 |
| Rate for Payer: Aetna Commercial |
$288.40
|
| 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 |
$310.83
|
| Rate for Payer: ASR Commercial |
$310.83
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$262.41
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$301.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$320.44
|
| Rate for Payer: Healthscope Whirlpool |
$310.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: Nomi Health Commercial |
$262.76
|
| 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 |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.77
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$224.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: ASR ASR |
$114.25
|
| Rate for Payer: ASR Commercial |
$114.25
|
| Rate for Payer: BCBS Trust/PPO |
$95.98
|
| Rate for Payer: BCN Commercial |
$91.31
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$110.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$117.78
|
| Rate for Payer: Healthscope Whirlpool |
$114.25
|
| Rate for Payer: Mclaren Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: Nomi Health Commercial |
$96.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.65
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Aetna Commercial |
$106.00
|
| Rate for Payer: Aetna Medicare |
$58.89
|
| Rate for Payer: ASR ASR |
$114.25
|
| Rate for Payer: ASR Commercial |
$114.25
|
| Rate for Payer: BCBS Complete |
$47.11
|
| Rate for Payer: BCBS Trust/PPO |
$96.45
|
| Rate for Payer: BCN Commercial |
$91.31
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$110.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$117.78
|
| Rate for Payer: Healthscope Whirlpool |
$114.25
|
| Rate for Payer: Mclaren Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: Nomi Health Commercial |
$96.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.20
|
| Rate for Payer: Priority Health Narrow Network |
$82.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.65
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$595.78
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$238.31 |
| Max. Negotiated Rate |
$595.78 |
| Rate for Payer: Aetna Commercial |
$536.20
|
| Rate for Payer: Aetna Medicare |
$297.89
|
| Rate for Payer: ASR ASR |
$577.91
|
| Rate for Payer: ASR Commercial |
$577.91
|
| Rate for Payer: BCBS Complete |
$238.31
|
| Rate for Payer: BCBS Trust/PPO |
$487.88
|
| Rate for Payer: BCN Commercial |
$461.91
|
| Rate for Payer: Cash Price |
$476.62
|
| Rate for Payer: Cofinity Commercial |
$560.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.62
|
| Rate for Payer: Healthscope Commercial |
$595.78
|
| Rate for Payer: Healthscope Whirlpool |
$577.91
|
| Rate for Payer: Mclaren Commercial |
$536.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.41
|
| Rate for Payer: Nomi Health Commercial |
$488.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.02
|
| Rate for Payer: Priority Health Narrow Network |
$417.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$524.29
|
|
