|
HC REPLACE SINGLE CHAMBER ICD
|
Facility
|
OP
|
$17,881.43
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,622.93 |
| Max. Negotiated Rate |
$33,931.55 |
| Rate for Payer: Aetna Commercial |
$16,093.29
|
| Rate for Payer: Aetna Medicare |
$21,891.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,364.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,364.15
|
| Rate for Payer: ASR ASR |
$17,344.99
|
| Rate for Payer: ASR Commercial |
$17,344.99
|
| Rate for Payer: BCBS Complete |
$12,320.43
|
| Rate for Payer: BCBS MAPPO |
$21,891.32
|
| Rate for Payer: BCBS Trust/PPO |
$14,643.10
|
| Rate for Payer: BCN Commercial |
$13,863.47
|
| Rate for Payer: BCN Medicare Advantage |
$21,891.32
|
| Rate for Payer: Cash Price |
$14,305.14
|
| Rate for Payer: Cash Price |
$14,305.14
|
| Rate for Payer: Cofinity Commercial |
$16,808.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,305.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,891.32
|
| Rate for Payer: Healthscope Commercial |
$17,881.43
|
| Rate for Payer: Healthscope Whirlpool |
$17,344.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,891.32
|
| Rate for Payer: Mclaren Commercial |
$16,093.29
|
| Rate for Payer: Mclaren Medicaid |
$11,733.75
|
| Rate for Payer: Mclaren Medicare |
$21,891.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,985.89
|
| Rate for Payer: Meridian Medicaid |
$12,320.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,175.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,199.22
|
| Rate for Payer: Nomi Health Commercial |
$14,662.77
|
| Rate for Payer: PACE Medicare |
$20,796.75
|
| Rate for Payer: PACE SWMI |
$21,891.32
|
| Rate for Payer: PHP Commercial |
$24,080.45
|
| Rate for Payer: PHP Medicaid |
$11,733.75
|
| Rate for Payer: PHP Medicare Advantage |
$21,891.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,733.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,622.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,667.71
|
| Rate for Payer: Priority Health Medicare |
$21,891.32
|
| Rate for Payer: Priority Health Narrow Network |
$12,534.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21,891.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,735.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,891.32
|
| Rate for Payer: UHC Exchange |
$33,931.55
|
| Rate for Payer: UHC Medicare Advantage |
$21,891.32
|
| Rate for Payer: UHCCP DNSP |
$21,891.32
|
| Rate for Payer: UHCCP Medicaid |
$11,733.75
|
| Rate for Payer: VA VA |
$21,891.32
|
|
|
HC REPLACE SINGLE CHAMBER PPM
|
Facility
|
IP
|
$12,181.07
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
36100354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,917.70 |
| Max. Negotiated Rate |
$12,181.07 |
| Rate for Payer: Aetna Commercial |
$10,962.96
|
| Rate for Payer: ASR ASR |
$11,815.64
|
| Rate for Payer: ASR Commercial |
$11,815.64
|
| Rate for Payer: BCBS Trust/PPO |
$9,926.35
|
| Rate for Payer: BCN Commercial |
$9,443.98
|
| Rate for Payer: Cash Price |
$9,744.86
|
| Rate for Payer: Cofinity Commercial |
$11,450.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,744.86
|
| Rate for Payer: Healthscope Commercial |
$12,181.07
|
| Rate for Payer: Healthscope Whirlpool |
$11,815.64
|
| Rate for Payer: Mclaren Commercial |
$10,962.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,353.91
|
| Rate for Payer: Nomi Health Commercial |
$9,988.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,917.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,719.34
|
|
|
HC REPLACE SINGLE CHAMBER PPM
|
Facility
|
OP
|
$12,181.07
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
36100354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,326.27 |
| Max. Negotiated Rate |
$12,510.67 |
| Rate for Payer: Aetna Commercial |
$10,962.96
|
| Rate for Payer: Aetna Medicare |
$8,071.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: ASR ASR |
$11,815.64
|
| Rate for Payer: ASR Commercial |
$11,815.64
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCBS Trust/PPO |
$9,975.08
|
| Rate for Payer: BCN Commercial |
$9,443.98
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$9,744.86
|
| Rate for Payer: Cash Price |
$9,744.86
|
| Rate for Payer: Cofinity Commercial |
$11,450.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,744.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$12,181.07
|
| Rate for Payer: Healthscope Whirlpool |
$11,815.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,071.40
|
| Rate for Payer: Mclaren Commercial |
$10,962.96
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,353.91
|
| Rate for Payer: Nomi Health Commercial |
$9,988.48
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$8,878.54
|
| Rate for Payer: PHP Medicaid |
$4,326.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,917.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,673.05
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health Narrow Network |
$8,538.93
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,719.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Exchange |
$12,510.67
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP DNSP |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,326.27
|
| Rate for Payer: VA VA |
$8,071.40
|
|
|
HC REPLACE SQ ICD ONLY
|
Facility
|
IP
|
$36,230.98
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23,550.14 |
| Max. Negotiated Rate |
$36,230.98 |
| Rate for Payer: Aetna Commercial |
$32,607.88
|
| Rate for Payer: ASR ASR |
$35,144.05
|
| Rate for Payer: ASR Commercial |
$35,144.05
|
| Rate for Payer: BCBS Trust/PPO |
$29,524.63
|
| Rate for Payer: BCN Commercial |
$28,089.88
|
| Rate for Payer: Cash Price |
$28,984.78
|
| Rate for Payer: Cofinity Commercial |
$34,057.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,984.78
|
| Rate for Payer: Healthscope Commercial |
$36,230.98
|
| Rate for Payer: Healthscope Whirlpool |
$35,144.05
|
| Rate for Payer: Mclaren Commercial |
$32,607.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,796.33
|
| Rate for Payer: Nomi Health Commercial |
$29,709.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,550.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31,883.26
|
|
|
HC REPLACE SQ ICD ONLY
|
Facility
|
OP
|
$36,230.98
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,733.75 |
| Max. Negotiated Rate |
$36,230.98 |
| Rate for Payer: Aetna Commercial |
$32,607.88
|
| Rate for Payer: Aetna Medicare |
$21,891.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,364.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,364.15
|
| Rate for Payer: ASR ASR |
$35,144.05
|
| Rate for Payer: ASR Commercial |
$35,144.05
|
| Rate for Payer: BCBS Complete |
$12,320.43
|
| Rate for Payer: BCBS MAPPO |
$21,891.32
|
| Rate for Payer: BCBS Trust/PPO |
$29,669.55
|
| Rate for Payer: BCN Commercial |
$28,089.88
|
| Rate for Payer: BCN Medicare Advantage |
$21,891.32
|
| Rate for Payer: Cash Price |
$28,984.78
|
| Rate for Payer: Cash Price |
$28,984.78
|
| Rate for Payer: Cofinity Commercial |
$34,057.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,984.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,891.32
|
| Rate for Payer: Healthscope Commercial |
$36,230.98
|
| Rate for Payer: Healthscope Whirlpool |
$35,144.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,891.32
|
| Rate for Payer: Mclaren Commercial |
$32,607.88
|
| Rate for Payer: Mclaren Medicaid |
$11,733.75
|
| Rate for Payer: Mclaren Medicare |
$21,891.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,985.89
|
| Rate for Payer: Meridian Medicaid |
$12,320.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,175.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,796.33
|
| Rate for Payer: Nomi Health Commercial |
$29,709.40
|
| Rate for Payer: PACE Medicare |
$20,796.75
|
| Rate for Payer: PACE SWMI |
$21,891.32
|
| Rate for Payer: PHP Commercial |
$24,080.45
|
| Rate for Payer: PHP Medicaid |
$11,733.75
|
| Rate for Payer: PHP Medicare Advantage |
$21,891.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,733.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,550.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,745.58
|
| Rate for Payer: Priority Health Medicare |
$21,891.32
|
| Rate for Payer: Priority Health Narrow Network |
$25,397.92
|
| Rate for Payer: Railroad Medicare Medicare |
$21,891.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31,883.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,891.32
|
| Rate for Payer: UHC Exchange |
$33,931.55
|
| Rate for Payer: UHC Medicare Advantage |
$21,891.32
|
| Rate for Payer: UHCCP DNSP |
$21,891.32
|
| Rate for Payer: UHCCP Medicaid |
$11,733.75
|
| Rate for Payer: VA VA |
$21,891.32
|
|
|
HC REPOSITION CVAC
|
Facility
|
OP
|
$2,508.82
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
36100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$2,508.82 |
| Rate for Payer: Aetna Commercial |
$2,257.94
|
| Rate for Payer: Aetna Medicare |
$1,515.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: ASR ASR |
$2,433.56
|
| Rate for Payer: ASR Commercial |
$2,433.56
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.47
|
| Rate for Payer: BCN Commercial |
$1,945.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$2,007.06
|
| Rate for Payer: Cash Price |
$2,007.06
|
| Rate for Payer: Cofinity Commercial |
$2,358.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,515.04
|
| Rate for Payer: Mclaren Commercial |
$2,257.94
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.50
|
| Rate for Payer: Nomi Health Commercial |
$2,057.23
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,666.54
|
| Rate for Payer: PHP Medicaid |
$812.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,198.23
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,758.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP DNSP |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC REPOSITION CVAC
|
Facility
|
IP
|
$2,508.82
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
36100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,630.73 |
| Max. Negotiated Rate |
$2,508.82 |
| Rate for Payer: Aetna Commercial |
$2,257.94
|
| Rate for Payer: ASR ASR |
$2,433.56
|
| Rate for Payer: ASR Commercial |
$2,433.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,044.44
|
| Rate for Payer: BCN Commercial |
$1,945.09
|
| Rate for Payer: Cash Price |
$2,007.06
|
| Rate for Payer: Cofinity Commercial |
$2,358.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.06
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.56
|
| Rate for Payer: Mclaren Commercial |
$2,257.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.50
|
| Rate for Payer: Nomi Health Commercial |
$2,057.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.76
|
|
|
HC REPOSITION RA/RV ELECTRODE
|
Facility
|
IP
|
$2,941.63
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
36100064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,912.06 |
| Max. Negotiated Rate |
$2,941.63 |
| Rate for Payer: Aetna Commercial |
$2,647.47
|
| Rate for Payer: ASR ASR |
$2,853.38
|
| Rate for Payer: ASR Commercial |
$2,853.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,397.13
|
| Rate for Payer: BCN Commercial |
$2,280.65
|
| Rate for Payer: Cash Price |
$2,353.30
|
| Rate for Payer: Cofinity Commercial |
$2,765.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,353.30
|
| Rate for Payer: Healthscope Commercial |
$2,941.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,853.38
|
| Rate for Payer: Mclaren Commercial |
$2,647.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,500.39
|
| Rate for Payer: Nomi Health Commercial |
$2,412.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,588.63
|
|
|
HC REPOSITION RA/RV ELECTRODE
|
Facility
|
OP
|
$2,941.63
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
36100064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$2,647.47
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$2,853.38
|
| Rate for Payer: ASR Commercial |
$2,853.38
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,408.90
|
| Rate for Payer: BCN Commercial |
$2,280.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,353.30
|
| Rate for Payer: Cash Price |
$2,353.30
|
| Rate for Payer: Cofinity Commercial |
$2,765.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,353.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,941.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,853.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$2,647.47
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,500.39
|
| Rate for Payer: Nomi Health Commercial |
$2,412.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,577.46
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,062.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,588.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC RESERVOIR 20 MICRON
|
Facility
|
OP
|
$107.10
|
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$53.55
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Complete |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.84
|
| Rate for Payer: Priority Health Narrow Network |
$75.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC RESERVOIR 20 MICRON
|
Facility
|
IP
|
$107.10
|
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.28
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
IP
|
$30.60
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
OP
|
$30.60
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
IP
|
$30.60
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
OP
|
$30.60
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
OP
|
$841.50
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$757.35
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: ASR ASR |
$816.25
|
| Rate for Payer: ASR Commercial |
$816.25
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS Trust/PPO |
$689.10
|
| Rate for Payer: BCN Commercial |
$652.41
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$841.50
|
| Rate for Payer: Healthscope Whirlpool |
$816.25
|
| Rate for Payer: Mclaren Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.27
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.32
|
| Rate for Payer: Priority Health Narrow Network |
$589.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.52
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
IP
|
$841.50
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$757.35
|
| Rate for Payer: ASR ASR |
$816.25
|
| Rate for Payer: ASR Commercial |
$816.25
|
| Rate for Payer: BCBS Trust/PPO |
$685.74
|
| Rate for Payer: BCN Commercial |
$652.41
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$841.50
|
| Rate for Payer: Healthscope Whirlpool |
$816.25
|
| Rate for Payer: Mclaren Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.27
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.52
|
|
|
HC RESPIRATORY ALLERGEN PROFILE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
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 RESPIRATORY ALLERGEN PROFILE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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 RESPIRATORY FLOW VOLUME
|
Facility
|
OP
|
$178.41
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$470.74 |
| Rate for Payer: Aetna Commercial |
$160.57
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$173.06
|
| Rate for Payer: ASR Commercial |
$173.06
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$146.10
|
| Rate for Payer: BCN Commercial |
$138.32
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$142.73
|
| Rate for Payer: Cash Price |
$142.73
|
| Rate for Payer: Cofinity Commercial |
$167.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$178.41
|
| Rate for Payer: Healthscope Whirlpool |
$173.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$160.57
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.65
|
| Rate for Payer: Nomi Health Commercial |
$146.30
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.32
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$125.07
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC RESPIRATORY FLOW VOLUME
|
Facility
|
IP
|
$178.41
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$178.41 |
| Rate for Payer: Aetna Commercial |
$160.57
|
| Rate for Payer: ASR ASR |
$173.06
|
| Rate for Payer: ASR Commercial |
$173.06
|
| Rate for Payer: BCBS Trust/PPO |
$145.39
|
| Rate for Payer: BCN Commercial |
$138.32
|
| Rate for Payer: Cash Price |
$142.73
|
| Rate for Payer: Cofinity Commercial |
$167.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.73
|
| Rate for Payer: Healthscope Commercial |
$178.41
|
| Rate for Payer: Healthscope Whirlpool |
$173.06
|
| Rate for Payer: Mclaren Commercial |
$160.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.65
|
| Rate for Payer: Nomi Health Commercial |
$146.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.00
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
OP
|
$1,054.61
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$421.84 |
| Max. Negotiated Rate |
$1,054.61 |
| Rate for Payer: Aetna Commercial |
$949.15
|
| Rate for Payer: Aetna Medicare |
$527.30
|
| Rate for Payer: ASR ASR |
$1,022.97
|
| Rate for Payer: ASR Commercial |
$1,022.97
|
| Rate for Payer: BCBS Complete |
$421.84
|
| Rate for Payer: BCBS Trust/PPO |
$863.62
|
| Rate for Payer: BCN Commercial |
$817.64
|
| Rate for Payer: Cash Price |
$843.69
|
| Rate for Payer: Cofinity Commercial |
$991.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.69
|
| Rate for Payer: Healthscope Commercial |
$1,054.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.97
|
| Rate for Payer: Mclaren Commercial |
$949.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.42
|
| Rate for Payer: Nomi Health Commercial |
$864.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$924.05
|
| Rate for Payer: Priority Health Narrow Network |
$739.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$928.06
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
IP
|
$1,054.61
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$1,054.61 |
| Rate for Payer: Aetna Commercial |
$949.15
|
| Rate for Payer: ASR ASR |
$1,022.97
|
| Rate for Payer: ASR Commercial |
$1,022.97
|
| Rate for Payer: BCBS Trust/PPO |
$859.40
|
| Rate for Payer: BCN Commercial |
$817.64
|
| Rate for Payer: Cash Price |
$843.69
|
| Rate for Payer: Cofinity Commercial |
$991.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.69
|
| Rate for Payer: Healthscope Commercial |
$1,054.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.97
|
| Rate for Payer: Mclaren Commercial |
$949.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.42
|
| Rate for Payer: Nomi Health Commercial |
$864.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$928.06
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS AG
|
Facility
|
OP
|
$101.59
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30600175
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$101.59 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.38
|
| Rate for Payer: ASR ASR |
$98.54
|
| Rate for Payer: ASR Commercial |
$98.54
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$83.19
|
| Rate for Payer: BCN Commercial |
$78.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.10
|
| Rate for Payer: Cash Price |
$81.27
|
| Rate for Payer: Cash Price |
$81.27
|
| Rate for Payer: Cofinity Commercial |
$95.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$101.59
|
| Rate for Payer: Healthscope Whirlpool |
$98.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$91.43
|
| Rate for Payer: Mclaren Medicaid |
$7.02
|
| Rate for Payer: Mclaren Medicare |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.35
|
| Rate for Payer: Nomi Health Commercial |
$83.30
|
| Rate for Payer: PACE Medicare |
$12.45
|
| Rate for Payer: PACE SWMI |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.41
|
| Rate for Payer: PHP Medicaid |
$7.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.01
|
| Rate for Payer: Priority Health Medicare |
$13.10
|
| Rate for Payer: Priority Health Narrow Network |
$71.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.10
|
| Rate for Payer: UHC Exchange |
$20.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.10
|
| Rate for Payer: UHCCP DNSP |
$13.10
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$13.10
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS AG
|
Facility
|
IP
|
$101.59
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30600175
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$101.59 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: ASR ASR |
$98.54
|
| Rate for Payer: ASR Commercial |
$98.54
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$78.76
|
| Rate for Payer: Cash Price |
$81.27
|
| Rate for Payer: Cofinity Commercial |
$95.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.27
|
| Rate for Payer: Healthscope Commercial |
$101.59
|
| Rate for Payer: Healthscope Whirlpool |
$98.54
|
| Rate for Payer: Mclaren Commercial |
$91.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.35
|
| Rate for Payer: Nomi Health Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.40
|
|
