|
HC RF ABLATION LIVER TUMOR
|
Facility
|
IP
|
$5,885.87
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,825.82 |
| Max. Negotiated Rate |
$5,885.87 |
| Rate for Payer: Aetna Commercial |
$5,297.28
|
| Rate for Payer: ASR ASR |
$5,709.29
|
| Rate for Payer: ASR Commercial |
$5,709.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,796.40
|
| Rate for Payer: BCN Commercial |
$4,563.32
|
| Rate for Payer: Cash Price |
$4,708.70
|
| Rate for Payer: Cofinity Commercial |
$5,532.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,708.70
|
| Rate for Payer: Healthscope Commercial |
$5,885.87
|
| Rate for Payer: Healthscope Whirlpool |
$5,709.29
|
| Rate for Payer: Mclaren Commercial |
$5,297.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,002.99
|
| Rate for Payer: Nomi Health Commercial |
$4,826.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,825.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,179.57
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
OP
|
$2,683.22
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,025.52 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$2,414.90
|
| Rate for Payer: Aetna Medicare |
$1,913.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: ASR ASR |
$2,602.72
|
| Rate for Payer: ASR Commercial |
$2,602.72
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,197.29
|
| Rate for Payer: BCN Commercial |
$2,080.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cofinity Commercial |
$2,522.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$2,683.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,602.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$2,414.90
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.74
|
| Rate for Payer: Nomi Health Commercial |
$2,200.24
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,104.61
|
| Rate for Payer: PHP Medicaid |
$1,025.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.27
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,574.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,361.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,965.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP DNSP |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
IP
|
$2,683.22
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,744.09 |
| Max. Negotiated Rate |
$2,683.22 |
| Rate for Payer: Aetna Commercial |
$2,414.90
|
| Rate for Payer: ASR ASR |
$2,602.72
|
| Rate for Payer: ASR Commercial |
$2,602.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,186.56
|
| Rate for Payer: BCN Commercial |
$2,080.30
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cofinity Commercial |
$2,522.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.58
|
| Rate for Payer: Healthscope Commercial |
$2,683.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,602.72
|
| Rate for Payer: Mclaren Commercial |
$2,414.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.74
|
| Rate for Payer: Nomi Health Commercial |
$2,200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,361.23
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
IP
|
$1,788.52
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,162.54 |
| Max. Negotiated Rate |
$1,788.52 |
| Rate for Payer: Aetna Commercial |
$1,609.67
|
| Rate for Payer: ASR ASR |
$1,734.86
|
| Rate for Payer: ASR Commercial |
$1,734.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.46
|
| Rate for Payer: BCN Commercial |
$1,386.64
|
| Rate for Payer: Cash Price |
$1,430.82
|
| Rate for Payer: Cofinity Commercial |
$1,681.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,430.82
|
| Rate for Payer: Healthscope Commercial |
$1,788.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,734.86
|
| Rate for Payer: Mclaren Commercial |
$1,609.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.24
|
| Rate for Payer: Nomi Health Commercial |
$1,466.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,573.90
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
OP
|
$1,788.52
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.41 |
| Max. Negotiated Rate |
$1,788.52 |
| Rate for Payer: Aetna Commercial |
$1,609.67
|
| Rate for Payer: Aetna Medicare |
$894.26
|
| Rate for Payer: ASR ASR |
$1,734.86
|
| Rate for Payer: ASR Commercial |
$1,734.86
|
| Rate for Payer: BCBS Complete |
$715.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.62
|
| Rate for Payer: BCN Commercial |
$1,386.64
|
| Rate for Payer: Cash Price |
$1,430.82
|
| Rate for Payer: Cofinity Commercial |
$1,681.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,430.82
|
| Rate for Payer: Healthscope Commercial |
$1,788.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,734.86
|
| Rate for Payer: Mclaren Commercial |
$1,609.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.24
|
| Rate for Payer: Nomi Health Commercial |
$1,466.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,567.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,253.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,573.90
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$74.68 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.09
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.67
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.67
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Mclaren Medicare |
$5.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$5.39
|
| Rate for Payer: PACE SWMI |
$5.67
|
| Rate for Payer: PHP Commercial |
$6.24
|
| Rate for Payer: PHP Medicaid |
$3.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.68
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow Network |
$59.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.67
|
| Rate for Payer: UHC Exchange |
$8.79
|
| Rate for Payer: UHC Medicare Advantage |
$5.67
|
| Rate for Payer: UHCCP DNSP |
$5.67
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$5.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC RHOGAM
|
Facility
|
OP
|
$283.98
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$283.98 |
| Rate for Payer: Aetna Commercial |
$255.58
|
| Rate for Payer: Aetna Medicare |
$141.99
|
| Rate for Payer: ASR ASR |
$275.46
|
| Rate for Payer: ASR Commercial |
$275.46
|
| Rate for Payer: BCBS Complete |
$113.59
|
| Rate for Payer: BCBS Trust/PPO |
$232.55
|
| Rate for Payer: BCN Commercial |
$220.17
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Commercial |
$266.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$283.98
|
| Rate for Payer: Healthscope Whirlpool |
$275.46
|
| Rate for Payer: Mclaren Commercial |
$255.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Nomi Health Commercial |
$232.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.07
|
| Rate for Payer: Priority Health Narrow Network |
$64.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.90
|
|
|
HC RHOGAM
|
Facility
|
IP
|
$283.98
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$283.98 |
| Rate for Payer: Aetna Commercial |
$255.58
|
| Rate for Payer: ASR ASR |
$275.46
|
| Rate for Payer: ASR Commercial |
$275.46
|
| Rate for Payer: BCBS Trust/PPO |
$231.42
|
| Rate for Payer: BCN Commercial |
$220.17
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Commercial |
$266.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$283.98
|
| Rate for Payer: Healthscope Whirlpool |
$275.46
|
| Rate for Payer: Mclaren Commercial |
$255.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Nomi Health Commercial |
$232.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.90
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$153.73 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| 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 |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| 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 |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$122.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
OP
|
$3,767.24
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$637.54 |
| Max. Negotiated Rate |
$3,767.24 |
| Rate for Payer: Aetna Commercial |
$3,390.52
|
| Rate for Payer: Aetna Medicare |
$1,189.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,486.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,486.80
|
| Rate for Payer: ASR ASR |
$3,654.22
|
| Rate for Payer: ASR Commercial |
$3,654.22
|
| Rate for Payer: BCBS Complete |
$669.42
|
| Rate for Payer: BCBS MAPPO |
$1,189.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,084.99
|
| Rate for Payer: BCN Commercial |
$2,920.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,189.44
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$3,541.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,189.44
|
| Rate for Payer: Healthscope Commercial |
$3,767.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,189.44
|
| Rate for Payer: Mclaren Commercial |
$3,390.52
|
| Rate for Payer: Mclaren Medicaid |
$637.54
|
| Rate for Payer: Mclaren Medicare |
$1,189.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,248.91
|
| Rate for Payer: Meridian Medicaid |
$669.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,367.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: Nomi Health Commercial |
$3,089.14
|
| Rate for Payer: PACE Medicare |
$1,129.97
|
| Rate for Payer: PACE SWMI |
$1,189.44
|
| Rate for Payer: PHP Commercial |
$1,308.38
|
| Rate for Payer: PHP Medicaid |
$637.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,189.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,300.86
|
| Rate for Payer: Priority Health Medicare |
$1,189.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,640.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,189.44
|
| Rate for Payer: UHC Exchange |
$1,843.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,189.44
|
| Rate for Payer: UHCCP DNSP |
$1,189.44
|
| Rate for Payer: UHCCP Medicaid |
$637.54
|
| Rate for Payer: VA VA |
$1,189.44
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
IP
|
$3,767.24
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,448.71 |
| Max. Negotiated Rate |
$3,767.24 |
| Rate for Payer: Aetna Commercial |
$3,390.52
|
| Rate for Payer: ASR ASR |
$3,654.22
|
| Rate for Payer: ASR Commercial |
$3,654.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,069.92
|
| Rate for Payer: BCN Commercial |
$2,920.74
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$3,541.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Healthscope Commercial |
$3,767.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.22
|
| Rate for Payer: Mclaren Commercial |
$3,390.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: Nomi Health Commercial |
$3,089.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.17
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$113.22
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| Rate for Payer: ASR ASR |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$113.22
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: ASR ASR |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Complete |
$45.29
|
| Rate for Payer: BCBS Trust/PPO |
$92.72
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.20
|
| Rate for Payer: Priority Health Narrow Network |
$79.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$69.08
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$62.17
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$67.01
|
| Rate for Payer: ASR Commercial |
$67.01
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$56.57
|
| Rate for Payer: BCN Commercial |
$53.56
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$64.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Healthscope Whirlpool |
$67.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$62.17
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.72
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.53
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$48.43
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$69.08
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$62.17
|
| Rate for Payer: ASR ASR |
$67.01
|
| Rate for Payer: ASR Commercial |
$67.01
|
| Rate for Payer: BCBS Trust/PPO |
$56.29
|
| Rate for Payer: BCN Commercial |
$53.56
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$64.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.26
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Healthscope Whirlpool |
$67.01
|
| Rate for Payer: Mclaren Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.72
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.79
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$95.17
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: ASR ASR |
$92.31
|
| Rate for Payer: ASR Commercial |
$92.31
|
| Rate for Payer: BCBS Trust/PPO |
$77.55
|
| Rate for Payer: BCN Commercial |
$73.79
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Commercial |
$89.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Healthscope Whirlpool |
$92.31
|
| Rate for Payer: Mclaren Commercial |
$85.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.75
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$95.17
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$47.58
|
| Rate for Payer: ASR ASR |
$92.31
|
| Rate for Payer: ASR Commercial |
$92.31
|
| Rate for Payer: BCBS Complete |
$38.07
|
| Rate for Payer: BCBS Trust/PPO |
$77.93
|
| Rate for Payer: BCN Commercial |
$73.79
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Commercial |
$89.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Healthscope Whirlpool |
$92.31
|
| Rate for Payer: Mclaren Commercial |
$85.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.40
|
| Rate for Payer: Priority Health Narrow Network |
$58.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.75
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$11,199.49
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,279.67 |
| Max. Negotiated Rate |
$11,199.49 |
| Rate for Payer: Aetna Commercial |
$10,079.54
|
| Rate for Payer: ASR ASR |
$10,863.51
|
| Rate for Payer: ASR Commercial |
$10,863.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,126.46
|
| Rate for Payer: BCN Commercial |
$8,682.96
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cofinity Commercial |
$10,527.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.59
|
| Rate for Payer: Healthscope Commercial |
$11,199.49
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.51
|
| Rate for Payer: Mclaren Commercial |
$10,079.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.57
|
| Rate for Payer: Nomi Health Commercial |
$9,183.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.55
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$11,199.49
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.13 |
| Max. Negotiated Rate |
$11,199.49 |
| Rate for Payer: Aetna Commercial |
$10,079.54
|
| Rate for Payer: Aetna Medicare |
$3,151.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.21
|
| Rate for Payer: ASR ASR |
$10,863.51
|
| Rate for Payer: ASR Commercial |
$10,863.51
|
| Rate for Payer: BCBS Complete |
$1,773.59
|
| Rate for Payer: BCBS MAPPO |
$3,151.37
|
| Rate for Payer: BCBS Trust/PPO |
$9,171.26
|
| Rate for Payer: BCN Commercial |
$8,682.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.37
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cofinity Commercial |
$10,527.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.37
|
| Rate for Payer: Healthscope Commercial |
$11,199.49
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,151.37
|
| Rate for Payer: Mclaren Commercial |
$10,079.54
|
| Rate for Payer: Mclaren Medicaid |
$1,689.13
|
| Rate for Payer: Mclaren Medicare |
$3,151.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.94
|
| Rate for Payer: Meridian Medicaid |
$1,773.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,624.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.57
|
| Rate for Payer: Nomi Health Commercial |
$9,183.58
|
| Rate for Payer: PACE Medicare |
$2,993.80
|
| Rate for Payer: PACE SWMI |
$3,151.37
|
| Rate for Payer: PHP Commercial |
$3,466.51
|
| Rate for Payer: PHP Medicaid |
$1,689.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,812.99
|
| Rate for Payer: Priority Health Medicare |
$3,151.37
|
| Rate for Payer: Priority Health Narrow Network |
$7,850.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,151.37
|
| Rate for Payer: UHC Exchange |
$4,884.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.37
|
| Rate for Payer: UHCCP DNSP |
$3,151.37
|
| Rate for Payer: UHCCP Medicaid |
$1,689.13
|
| Rate for Payer: VA VA |
$3,151.37
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.82 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.90
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.02
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$80.82
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.32
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.35 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: ASR ASR |
$348.23
|
| Rate for Payer: ASR Commercial |
$348.23
|
| Rate for Payer: BCBS Trust/PPO |
$292.55
|
| Rate for Payer: BCN Commercial |
$278.33
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$337.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.20
|
| Rate for Payer: Healthscope Commercial |
$359.00
|
| Rate for Payer: Healthscope Whirlpool |
$348.23
|
| Rate for Payer: Mclaren Commercial |
$323.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.15
|
| Rate for Payer: Nomi Health Commercial |
$294.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.92
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$348.23
|
| Rate for Payer: ASR Commercial |
$348.23
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$293.99
|
| Rate for Payer: BCN Commercial |
$278.33
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$337.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$359.00
|
| Rate for Payer: Healthscope Whirlpool |
$348.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$323.10
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.15
|
| Rate for Payer: Nomi Health Commercial |
$294.38
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.03
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$150.42
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
