|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,181.95 |
| Max. Negotiated Rate |
$3,356.84 |
| Rate for Payer: Aetna Commercial |
$3,021.16
|
| Rate for Payer: ASR ASR |
$3,256.13
|
| Rate for Payer: ASR Commercial |
$3,256.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.49
|
| Rate for Payer: BCN Commercial |
$2,602.56
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$3,155.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,356.84
|
| Rate for Payer: Healthscope Whirlpool |
$3,256.13
|
| Rate for Payer: Mclaren Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,954.02
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,352.06
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,528.84 |
| Max. Negotiated Rate |
$2,352.06 |
| Rate for Payer: Aetna Commercial |
$2,116.85
|
| Rate for Payer: ASR ASR |
$2,281.50
|
| Rate for Payer: ASR Commercial |
$2,281.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,916.69
|
| Rate for Payer: BCN Commercial |
$1,823.55
|
| Rate for Payer: Cash Price |
$1,881.65
|
| Rate for Payer: Cofinity Commercial |
$2,210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,881.65
|
| Rate for Payer: Healthscope Commercial |
$2,352.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,281.50
|
| Rate for Payer: Mclaren Commercial |
$2,116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.25
|
| Rate for Payer: Nomi Health Commercial |
$1,928.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,069.81
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| 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 |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| 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 RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
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 ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: ASR Commercial |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: ASR Commercial |
$3.96
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$199.76 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: ASR ASR |
$193.77
|
| Rate for Payer: ASR Commercial |
$193.77
|
| Rate for Payer: BCBS Trust/PPO |
$162.78
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$187.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Healthscope Commercial |
$199.76
|
| Rate for Payer: Healthscope Whirlpool |
$193.77
|
| Rate for Payer: Mclaren Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.79
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$199.76 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$106.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.49
|
| Rate for Payer: ASR ASR |
$193.77
|
| Rate for Payer: ASR Commercial |
$193.77
|
| Rate for Payer: BCBS Complete |
$60.10
|
| Rate for Payer: BCBS MAPPO |
$106.79
|
| Rate for Payer: BCBS Trust/PPO |
$163.58
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: BCN Medicare Advantage |
$106.79
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$187.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.79
|
| Rate for Payer: Healthscope Commercial |
$199.76
|
| Rate for Payer: Healthscope Whirlpool |
$193.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$106.79
|
| Rate for Payer: Mclaren Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$57.24
|
| Rate for Payer: Mclaren Medicare |
$106.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.13
|
| Rate for Payer: Meridian Medicaid |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.80
|
| Rate for Payer: PACE Medicare |
$101.45
|
| Rate for Payer: PACE SWMI |
$106.79
|
| Rate for Payer: PHP Commercial |
$117.47
|
| Rate for Payer: PHP Medicaid |
$57.24
|
| Rate for Payer: PHP Medicare Advantage |
$106.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.03
|
| Rate for Payer: Priority Health Medicare |
$106.79
|
| Rate for Payer: Priority Health Narrow Network |
$140.03
|
| Rate for Payer: Railroad Medicare Medicare |
$106.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.79
|
| Rate for Payer: UHC Exchange |
$165.52
|
| Rate for Payer: UHC Medicare Advantage |
$106.79
|
| Rate for Payer: UHCCP DNSP |
$106.79
|
| Rate for Payer: UHCCP Medicaid |
$57.24
|
| Rate for Payer: VA VA |
$106.79
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,720.06 |
| Max. Negotiated Rate |
$4,184.71 |
| Rate for Payer: Aetna Commercial |
$3,766.24
|
| Rate for Payer: ASR ASR |
$4,059.17
|
| Rate for Payer: ASR Commercial |
$4,059.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,410.12
|
| Rate for Payer: BCN Commercial |
$3,244.41
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$3,933.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$4,184.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,059.17
|
| Rate for Payer: Mclaren Commercial |
$3,766.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: Nomi Health Commercial |
$3,431.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,682.54
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,673.88 |
| Max. Negotiated Rate |
$4,184.71 |
| Rate for Payer: Aetna Commercial |
$3,766.24
|
| Rate for Payer: Aetna Medicare |
$2,092.36
|
| Rate for Payer: ASR ASR |
$4,059.17
|
| Rate for Payer: ASR Commercial |
$4,059.17
|
| Rate for Payer: BCBS Complete |
$1,673.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,426.86
|
| Rate for Payer: BCN Commercial |
$3,244.41
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$3,933.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$4,184.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,059.17
|
| Rate for Payer: Mclaren Commercial |
$3,766.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: Nomi Health Commercial |
$3,431.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,666.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,933.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,682.54
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$109.75 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$106.46
|
| Rate for Payer: ASR Commercial |
$106.46
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$89.87
|
| Rate for Payer: BCN Commercial |
$85.09
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$103.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$109.75
|
| Rate for Payer: Healthscope Whirlpool |
$106.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$98.78
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.16
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$76.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$109.75 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: ASR ASR |
$106.46
|
| Rate for Payer: ASR Commercial |
$106.46
|
| Rate for Payer: BCBS Trust/PPO |
$89.44
|
| Rate for Payer: BCN Commercial |
$85.09
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$103.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$109.75
|
| Rate for Payer: Healthscope Whirlpool |
$106.46
|
| Rate for Payer: Mclaren Commercial |
$98.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.58
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.04 |
| Max. Negotiated Rate |
$178.53 |
| Rate for Payer: Aetna Commercial |
$160.68
|
| Rate for Payer: ASR ASR |
$173.17
|
| Rate for Payer: ASR Commercial |
$173.17
|
| Rate for Payer: BCBS Trust/PPO |
$145.48
|
| Rate for Payer: BCN Commercial |
$138.41
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$178.53
|
| Rate for Payer: Healthscope Whirlpool |
$173.17
|
| Rate for Payer: Mclaren Commercial |
$160.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: Nomi Health Commercial |
$146.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.11
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$178.53 |
| Rate for Payer: Aetna Commercial |
$160.68
|
| Rate for Payer: Aetna Medicare |
$89.27
|
| Rate for Payer: ASR ASR |
$173.17
|
| Rate for Payer: ASR Commercial |
$173.17
|
| Rate for Payer: BCBS Complete |
$71.41
|
| Rate for Payer: BCBS Trust/PPO |
$146.20
|
| Rate for Payer: BCN Commercial |
$138.41
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$178.53
|
| Rate for Payer: Healthscope Whirlpool |
$173.17
|
| Rate for Payer: Mclaren Commercial |
$160.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: Nomi Health Commercial |
$146.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.43
|
| Rate for Payer: Priority Health Narrow Network |
$125.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.11
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$77.41 |
| Rate for Payer: Aetna Commercial |
$69.67
|
| Rate for Payer: ASR ASR |
$75.09
|
| Rate for Payer: ASR Commercial |
$75.09
|
| Rate for Payer: BCBS Trust/PPO |
$63.08
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$77.41
|
| Rate for Payer: Healthscope Whirlpool |
$75.09
|
| Rate for Payer: Mclaren Commercial |
$69.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.12
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$77.41 |
| Rate for Payer: Aetna Commercial |
$69.67
|
| Rate for Payer: Aetna Medicare |
$38.70
|
| Rate for Payer: ASR ASR |
$75.09
|
| Rate for Payer: ASR Commercial |
$75.09
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS Trust/PPO |
$63.39
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$77.41
|
| Rate for Payer: Healthscope Whirlpool |
$75.09
|
| Rate for Payer: Mclaren Commercial |
$69.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.83
|
| Rate for Payer: Priority Health Narrow Network |
$54.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.12
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$521.24 |
| Rate for Payer: Aetna Commercial |
$469.12
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: ASR ASR |
$505.60
|
| Rate for Payer: ASR Commercial |
$505.60
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCBS Trust/PPO |
$426.84
|
| Rate for Payer: BCN Commercial |
$404.12
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$489.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$521.24
|
| Rate for Payer: Healthscope Whirlpool |
$505.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$129.49
|
| Rate for Payer: Mclaren Commercial |
$469.12
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$427.42
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$142.44
|
| Rate for Payer: PHP Medicaid |
$69.41
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.71
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health Narrow Network |
$365.39
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$200.71
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP DNSP |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.81 |
| Max. Negotiated Rate |
$521.24 |
| Rate for Payer: Aetna Commercial |
$469.12
|
| Rate for Payer: ASR ASR |
$505.60
|
| Rate for Payer: ASR Commercial |
$505.60
|
| Rate for Payer: BCBS Trust/PPO |
$424.76
|
| Rate for Payer: BCN Commercial |
$404.12
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$489.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Healthscope Commercial |
$521.24
|
| Rate for Payer: Healthscope Whirlpool |
$505.60
|
| Rate for Payer: Mclaren Commercial |
$469.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$427.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.69
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$414.08 |
| Rate for Payer: Aetna Commercial |
$372.67
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: ASR ASR |
$401.66
|
| Rate for Payer: ASR Commercial |
$401.66
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCBS Trust/PPO |
$339.09
|
| Rate for Payer: BCN Commercial |
$321.04
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$389.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$414.08
|
| Rate for Payer: Healthscope Whirlpool |
$401.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$129.49
|
| Rate for Payer: Mclaren Commercial |
$372.67
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$339.55
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$142.44
|
| Rate for Payer: PHP Medicaid |
$69.41
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.82
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health Narrow Network |
$290.27
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$200.71
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP DNSP |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$414.08 |
| Rate for Payer: Aetna Commercial |
$372.67
|
| Rate for Payer: ASR ASR |
$401.66
|
| Rate for Payer: ASR Commercial |
$401.66
|
| Rate for Payer: BCBS Trust/PPO |
$337.43
|
| Rate for Payer: BCN Commercial |
$321.04
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$389.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Healthscope Commercial |
$414.08
|
| Rate for Payer: Healthscope Whirlpool |
$401.66
|
| Rate for Payer: Mclaren Commercial |
$372.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$339.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.39
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Trust/PPO |
$571.43
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$659.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: Aetna Medicare |
$256.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCBS Trust/PPO |
$574.24
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$659.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$256.48
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$282.13
|
| Rate for Payer: PHP Medicaid |
$137.47
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.42
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health Narrow Network |
$491.56
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$397.54
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP DNSP |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$137.47
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: ASR ASR |
$408.89
|
| Rate for Payer: ASR Commercial |
$408.89
|
| Rate for Payer: BCBS Trust/PPO |
$343.51
|
| Rate for Payer: BCN Commercial |
$326.82
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$396.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$421.54
|
| Rate for Payer: Healthscope Whirlpool |
$408.89
|
| Rate for Payer: Mclaren Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.96
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Medicare |
$256.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: ASR ASR |
$408.89
|
| Rate for Payer: ASR Commercial |
$408.89
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCBS Trust/PPO |
$345.20
|
| Rate for Payer: BCN Commercial |
$326.82
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$396.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$421.54
|
| Rate for Payer: Healthscope Whirlpool |
$408.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$256.48
|
| Rate for Payer: Mclaren Commercial |
$379.39
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$282.13
|
| Rate for Payer: PHP Medicaid |
$137.47
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.35
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health Narrow Network |
$295.50
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$397.54
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP DNSP |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$137.47
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$231.24 |
| Rate for Payer: Aetna Commercial |
$208.12
|
| Rate for Payer: ASR ASR |
$224.30
|
| Rate for Payer: ASR Commercial |
$224.30
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$179.28
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cofinity Commercial |
$217.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.99
|
| Rate for Payer: Healthscope Commercial |
$231.24
|
| Rate for Payer: Healthscope Whirlpool |
$224.30
|
| Rate for Payer: Mclaren Commercial |
$208.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: Nomi Health Commercial |
$189.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.49
|
|
