|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$63.25 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.35
|
| Rate for Payer: BCBS Trust/PPO |
$51.94
|
| Rate for Payer: BCN Commercial |
$51.94
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$61.35
|
| Rate for Payer: Healthscope Whirlpool |
$63.25
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.66
|
|
|
HC SARS FLU AB RSV
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$96.20
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS Trust/PPO |
$214.37
|
| Rate for Payer: BCN Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.81
|
| Rate for Payer: Priority Health Narrow Network |
$182.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
|
|
HC SARS FLU AB RSV
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Trust/PPO |
$213.51
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
|
|
HC SCALLOP IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
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 SCALLOP IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
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 SCALP ELECTRODE
|
Facility
|
IP
|
$136.45
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: ASR ASR |
$132.36
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$112.05
|
| Rate for Payer: Cash Price |
$109.16
|
| Rate for Payer: Cofinity Commercial |
$128.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.16
|
| Rate for Payer: Healthscope Commercial |
$132.36
|
| Rate for Payer: Healthscope Whirlpool |
$136.45
|
| Rate for Payer: Mclaren Commercial |
$122.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.98
|
| Rate for Payer: Nomi Health Commercial |
$111.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.08
|
|
|
HC SCALP ELECTRODE
|
Facility
|
OP
|
$136.45
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: ASR ASR |
$132.36
|
| Rate for Payer: BCBS Complete |
$54.58
|
| Rate for Payer: BCBS Trust/PPO |
$112.50
|
| Rate for Payer: BCN Commercial |
$112.50
|
| Rate for Payer: Cash Price |
$109.16
|
| Rate for Payer: Cofinity Commercial |
$128.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.16
|
| Rate for Payer: Healthscope Commercial |
$132.36
|
| Rate for Payer: Healthscope Whirlpool |
$136.45
|
| Rate for Payer: Mclaren Commercial |
$122.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.98
|
| Rate for Payer: Nomi Health Commercial |
$111.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$119.56
|
| Rate for Payer: Priority Health Narrow Network |
$95.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.08
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$101.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$91.58
|
| Rate for Payer: ASR ASR |
$98.71
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$83.57
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cofinity Commercial |
$95.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.41
|
| Rate for Payer: Healthscope Commercial |
$98.71
|
| Rate for Payer: Healthscope Whirlpool |
$101.76
|
| Rate for Payer: Mclaren Commercial |
$91.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.50
|
| Rate for Payer: Nomi Health Commercial |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.55
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$101.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$91.58
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: ASR ASR |
$98.71
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$83.90
|
| Rate for Payer: BCN Commercial |
$83.90
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cofinity Commercial |
$95.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$98.71
|
| Rate for Payer: Healthscope Whirlpool |
$101.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.01
|
| Rate for Payer: Mclaren Commercial |
$91.58
|
| Rate for Payer: Mclaren Medicaid |
$13.01
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.50
|
| Rate for Payer: Nomi Health Commercial |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.32
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Medicaid |
$6.97
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.16
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health Narrow Network |
$71.33
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.01
|
| Rate for Payer: UHC Exchange |
$20.17
|
| Rate for Payer: UHC Medicaid |
$6.80
|
| Rate for Payer: UHCCP DNSP |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC SCISSORS
|
Facility
|
OP
|
$18.02
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: ASR ASR |
$17.48
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$17.48
|
| Rate for Payer: Healthscope Whirlpool |
$18.02
|
| Rate for Payer: Mclaren Commercial |
$16.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Nomi Health Commercial |
$14.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.79
|
| Rate for Payer: Priority Health Narrow Network |
$12.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.86
|
|
|
HC SCISSORS
|
Facility
|
IP
|
$18.02
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: ASR ASR |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.80
|
| Rate for Payer: BCN Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$17.48
|
| Rate for Payer: Healthscope Whirlpool |
$18.02
|
| Rate for Payer: Mclaren Commercial |
$16.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Nomi Health Commercial |
$14.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.86
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$2,678.00 |
| Rate for Payer: Aetna Commercial |
$2,410.20
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$2,597.66
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,208.01
|
| Rate for Payer: BCN Commercial |
$2,208.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cofinity Commercial |
$2,517.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,597.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,678.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$2,410.20
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,276.30
|
| Rate for Payer: Nomi Health Commercial |
$2,195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,008.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,346.46
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,877.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,356.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,008.50 |
| Max. Negotiated Rate |
$2,678.00 |
| Rate for Payer: Aetna Commercial |
$2,410.20
|
| Rate for Payer: ASR ASR |
$2,597.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,199.17
|
| Rate for Payer: BCN Commercial |
$2,199.17
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cofinity Commercial |
$2,517.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,142.40
|
| Rate for Payer: Healthscope Commercial |
$2,597.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,678.00
|
| Rate for Payer: Mclaren Commercial |
$2,410.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,276.30
|
| Rate for Payer: Nomi Health Commercial |
$2,195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,008.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,356.64
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
IP
|
$80.16
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$80.16 |
| Rate for Payer: Aetna Commercial |
$72.14
|
| Rate for Payer: ASR ASR |
$77.76
|
| Rate for Payer: BCBS Trust/PPO |
$65.83
|
| Rate for Payer: BCN Commercial |
$65.83
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cofinity Commercial |
$75.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.13
|
| Rate for Payer: Healthscope Commercial |
$77.76
|
| Rate for Payer: Healthscope Whirlpool |
$80.16
|
| Rate for Payer: Mclaren Commercial |
$72.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.14
|
| Rate for Payer: Nomi Health Commercial |
$65.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.54
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
OP
|
$80.16
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$80.16 |
| Rate for Payer: Aetna Commercial |
$72.14
|
| Rate for Payer: Aetna Medicare |
$28.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: ASR ASR |
$77.76
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$66.09
|
| Rate for Payer: BCCCP Commercial |
$17.38
|
| Rate for Payer: BCN Commercial |
$66.09
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cofinity Commercial |
$75.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$77.76
|
| Rate for Payer: Healthscope Whirlpool |
$80.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.82
|
| Rate for Payer: Mclaren Commercial |
$72.14
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.14
|
| Rate for Payer: Nomi Health Commercial |
$65.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.12
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.70
|
| Rate for Payer: PHP Medicaid |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$70.24
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Narrow Network |
$56.19
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$44.67
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP DNSP |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$105.27
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$105.27 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: ASR ASR |
$102.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.45
|
| Rate for Payer: BCN Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$102.11
|
| Rate for Payer: Healthscope Whirlpool |
$105.27
|
| Rate for Payer: Mclaren Commercial |
$94.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.64
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$105.27
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$105.27 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Medicare |
$38.95
|
| Rate for Payer: ASR ASR |
$102.11
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.80
|
| Rate for Payer: BCCCP Commercial |
$49.44
|
| Rate for Payer: BCN Commercial |
$86.80
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$102.11
|
| Rate for Payer: Healthscope Whirlpool |
$105.27
|
| Rate for Payer: Mclaren Commercial |
$94.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.24
|
| Rate for Payer: Priority Health Narrow Network |
$73.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.64
|
|
|
HC SDL MSLT/MWT
|
Facility
|
OP
|
$2,623.63
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$2,844.82 |
| Rate for Payer: Aetna Commercial |
$2,361.27
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$2,544.92
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,163.18
|
| Rate for Payer: BCN Commercial |
$2,163.18
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$2,098.90
|
| Rate for Payer: Cash Price |
$2,098.90
|
| Rate for Payer: Cofinity Commercial |
$2,466.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,098.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$2,544.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,623.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$2,361.27
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,230.09
|
| Rate for Payer: Nomi Health Commercial |
$2,151.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,967.72
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,844.82
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,275.85
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,308.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC SDL MSLT/MWT
|
Facility
|
IP
|
$2,623.63
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,967.72 |
| Max. Negotiated Rate |
$2,623.63 |
| Rate for Payer: Aetna Commercial |
$2,361.27
|
| Rate for Payer: ASR ASR |
$2,544.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,154.52
|
| Rate for Payer: BCN Commercial |
$2,154.52
|
| Rate for Payer: Cash Price |
$2,098.90
|
| Rate for Payer: Cofinity Commercial |
$2,466.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,098.90
|
| Rate for Payer: Healthscope Commercial |
$2,544.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,623.63
|
| Rate for Payer: Mclaren Commercial |
$2,361.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,230.09
|
| Rate for Payer: Nomi Health Commercial |
$2,151.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,967.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,308.79
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
OP
|
$3,631.60
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$3,631.60 |
| Rate for Payer: Aetna Commercial |
$3,268.44
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$3,522.65
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,994.25
|
| Rate for Payer: BCN Commercial |
$2,994.25
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$2,905.28
|
| Rate for Payer: Cash Price |
$2,905.28
|
| Rate for Payer: Cofinity Commercial |
$3,413.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$3,522.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,631.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$3,268.44
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,086.86
|
| Rate for Payer: Nomi Health Commercial |
$2,977.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,723.70
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,272.14
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,617.71
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,195.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
IP
|
$3,631.60
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,723.70 |
| Max. Negotiated Rate |
$3,631.60 |
| Rate for Payer: Aetna Commercial |
$3,268.44
|
| Rate for Payer: ASR ASR |
$3,522.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,982.27
|
| Rate for Payer: BCN Commercial |
$2,982.27
|
| Rate for Payer: Cash Price |
$2,905.28
|
| Rate for Payer: Cofinity Commercial |
$3,413.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.28
|
| Rate for Payer: Healthscope Commercial |
$3,522.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,631.60
|
| Rate for Payer: Mclaren Commercial |
$3,268.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,086.86
|
| Rate for Payer: Nomi Health Commercial |
$2,977.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,723.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,195.81
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
IP
|
$4,014.94
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,011.20 |
| Max. Negotiated Rate |
$4,014.94 |
| Rate for Payer: Aetna Commercial |
$3,613.45
|
| Rate for Payer: ASR ASR |
$3,894.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,297.07
|
| Rate for Payer: BCN Commercial |
$3,297.07
|
| Rate for Payer: Cash Price |
$3,211.95
|
| Rate for Payer: Cofinity Commercial |
$3,774.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,211.95
|
| Rate for Payer: Healthscope Commercial |
$3,894.49
|
| Rate for Payer: Healthscope Whirlpool |
$4,014.94
|
| Rate for Payer: Mclaren Commercial |
$3,613.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,412.70
|
| Rate for Payer: Nomi Health Commercial |
$3,292.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,011.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,533.15
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
OP
|
$4,014.94
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$4,014.94 |
| Rate for Payer: Aetna Commercial |
$3,613.45
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$3,894.49
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,310.32
|
| Rate for Payer: BCN Commercial |
$3,310.32
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$3,211.95
|
| Rate for Payer: Cash Price |
$3,211.95
|
| Rate for Payer: Cofinity Commercial |
$3,774.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,211.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$3,894.49
|
| Rate for Payer: Healthscope Whirlpool |
$4,014.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$3,613.45
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,412.70
|
| Rate for Payer: Nomi Health Commercial |
$3,292.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,011.20
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,272.14
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,617.71
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,533.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
