|
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 |
$112.51 |
| 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: 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 |
$112.51
|
| Rate for Payer: Priority Health Narrow Network |
$90.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.12
|
|
|
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 INTERMED
|
Facility
|
OP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$521.24 |
| Rate for Payer: Aetna Commercial |
$469.12
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$505.60
|
| Rate for Payer: ASR Commercial |
$505.60
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$426.84
|
| Rate for Payer: BCN Commercial |
$404.12
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| 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 |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$521.24
|
| Rate for Payer: Healthscope Whirlpool |
$505.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$469.12
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$427.42
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| 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 |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$365.39
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
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 TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$414.08 |
| Rate for Payer: Aetna Commercial |
$372.67
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$401.66
|
| Rate for Payer: ASR Commercial |
$401.66
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$339.09
|
| Rate for Payer: BCN Commercial |
$321.04
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| 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 |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$414.08
|
| Rate for Payer: Healthscope Whirlpool |
$401.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$372.67
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$339.55
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| 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 |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$290.27
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
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 |
$138.11 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: Aetna Medicare |
$257.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.08
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Complete |
$145.01
|
| Rate for Payer: BCBS MAPPO |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$574.24
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: BCN Medicare Advantage |
$257.66
|
| 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 |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$138.11
|
| Rate for Payer: Mclaren Medicare |
$257.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.54
|
| Rate for Payer: Meridian Medicaid |
$145.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Medicare |
$244.78
|
| Rate for Payer: PACE SWMI |
$257.66
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicaid |
$138.11
|
| Rate for Payer: PHP Medicare Advantage |
$257.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.11
|
| 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 |
$257.66
|
| Rate for Payer: Priority Health Narrow Network |
$491.56
|
| Rate for Payer: Railroad Medicare Medicare |
$257.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.66
|
| Rate for Payer: UHC Exchange |
$399.37
|
| Rate for Payer: UHC Medicare Advantage |
$257.66
|
| Rate for Payer: UHCCP DNSP |
$257.66
|
| Rate for Payer: UHCCP Medicaid |
$138.11
|
| Rate for Payer: VA VA |
$257.66
|
|
|
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 INTERMEDIATE
|
Facility
|
OP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Medicare |
$257.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.08
|
| Rate for Payer: ASR ASR |
$408.89
|
| Rate for Payer: ASR Commercial |
$408.89
|
| Rate for Payer: BCBS Complete |
$145.01
|
| Rate for Payer: BCBS MAPPO |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$345.20
|
| Rate for Payer: BCN Commercial |
$326.82
|
| Rate for Payer: BCN Medicare Advantage |
$257.66
|
| 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 |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$421.54
|
| Rate for Payer: Healthscope Whirlpool |
$408.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$379.39
|
| Rate for Payer: Mclaren Medicaid |
$138.11
|
| Rate for Payer: Mclaren Medicare |
$257.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.54
|
| Rate for Payer: Meridian Medicaid |
$145.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PACE Medicare |
$244.78
|
| Rate for Payer: PACE SWMI |
$257.66
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicaid |
$138.11
|
| Rate for Payer: PHP Medicare Advantage |
$257.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.11
|
| 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 |
$257.66
|
| Rate for Payer: Priority Health Narrow Network |
$295.50
|
| Rate for Payer: Railroad Medicare Medicare |
$257.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.66
|
| Rate for Payer: UHC Exchange |
$399.37
|
| Rate for Payer: UHC Medicare Advantage |
$257.66
|
| Rate for Payer: UHCCP DNSP |
$257.66
|
| Rate for Payer: UHCCP Medicaid |
$138.11
|
| Rate for Payer: VA VA |
$257.66
|
|
|
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 SIMPLE
|
Facility
|
OP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$231.24 |
| Rate for Payer: Aetna Commercial |
$208.12
|
| Rate for Payer: Aetna Medicare |
$107.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.11
|
| Rate for Payer: ASR ASR |
$224.30
|
| Rate for Payer: ASR Commercial |
$224.30
|
| Rate for Payer: BCBS Complete |
$60.38
|
| Rate for Payer: BCBS MAPPO |
$107.29
|
| Rate for Payer: BCBS Trust/PPO |
$189.36
|
| Rate for Payer: BCN Commercial |
$179.28
|
| Rate for Payer: BCN Medicare Advantage |
$107.29
|
| Rate for Payer: Cash Price |
$184.99
|
| 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: Health Alliance Plan Medicare Advantage |
$107.29
|
| Rate for Payer: Healthscope Commercial |
$231.24
|
| Rate for Payer: Healthscope Whirlpool |
$224.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$107.29
|
| Rate for Payer: Mclaren Commercial |
$208.12
|
| Rate for Payer: Mclaren Medicaid |
$57.51
|
| Rate for Payer: Mclaren Medicare |
$107.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.65
|
| Rate for Payer: Meridian Medicaid |
$60.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: Nomi Health Commercial |
$189.62
|
| Rate for Payer: PACE Medicare |
$101.93
|
| Rate for Payer: PACE SWMI |
$107.29
|
| Rate for Payer: PHP Commercial |
$118.02
|
| Rate for Payer: PHP Medicaid |
$57.51
|
| Rate for Payer: PHP Medicare Advantage |
$107.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.61
|
| Rate for Payer: Priority Health Medicare |
$107.29
|
| Rate for Payer: Priority Health Narrow Network |
$162.10
|
| Rate for Payer: Railroad Medicare Medicare |
$107.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.29
|
| Rate for Payer: UHC Exchange |
$166.30
|
| Rate for Payer: UHC Medicare Advantage |
$107.29
|
| Rate for Payer: UHCCP DNSP |
$107.29
|
| Rate for Payer: UHCCP Medicaid |
$57.51
|
| Rate for Payer: VA VA |
$107.29
|
|
|
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
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
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 ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,838.87 |
| Max. Negotiated Rate |
$15,380.00 |
| Rate for Payer: Aetna Commercial |
$13,842.00
|
| Rate for Payer: Aetna Medicare |
$5,296.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: ASR ASR |
$14,918.60
|
| Rate for Payer: ASR Commercial |
$14,918.60
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$12,594.68
|
| Rate for Payer: BCN Commercial |
$11,924.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$14,457.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$15,380.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,918.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,296.40
|
| Rate for Payer: Mclaren Commercial |
$13,842.00
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: Nomi Health Commercial |
$12,611.60
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$5,826.04
|
| Rate for Payer: PHP Medicaid |
$2,838.87
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,475.96
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$10,781.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,534.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,209.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP DNSP |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,997.00 |
| Max. Negotiated Rate |
$15,380.00 |
| Rate for Payer: Aetna Commercial |
$13,842.00
|
| Rate for Payer: ASR ASR |
$14,918.60
|
| Rate for Payer: ASR Commercial |
$14,918.60
|
| Rate for Payer: BCBS Trust/PPO |
$12,533.16
|
| Rate for Payer: BCN Commercial |
$11,924.11
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$14,457.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Healthscope Commercial |
$15,380.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,918.60
|
| Rate for Payer: Mclaren Commercial |
$13,842.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: Nomi Health Commercial |
$12,611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,534.40
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| 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 |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.62
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
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 RPR TITER
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| 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 |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicaid |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: UHCCP DNSP |
$4.40
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
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 RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$110.24 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$39.51
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.20
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$37.63
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$39.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$77.22
|
| Rate for Payer: PHP Medicaid |
$37.63
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.24
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health Narrow Network |
$88.19
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.20
|
| Rate for Payer: UHC Exchange |
$108.81
|
| Rate for Payer: UHC Medicare Advantage |
$70.20
|
| Rate for Payer: UHCCP DNSP |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$37.63
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,302.54 |
| Rate for Payer: Aetna Commercial |
$1,172.29
|
| Rate for Payer: Aetna Medicare |
$651.27
|
| Rate for Payer: ASR ASR |
$1,263.46
|
| Rate for Payer: ASR Commercial |
$1,263.46
|
| Rate for Payer: BCBS Complete |
$521.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.65
|
| Rate for Payer: BCN Commercial |
$1,009.86
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,224.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,302.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.46
|
| Rate for Payer: Mclaren Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.99
|
| Rate for Payer: Priority Health Narrow Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.24
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.65 |
| Max. Negotiated Rate |
$1,302.54 |
| Rate for Payer: Aetna Commercial |
$1,172.29
|
| Rate for Payer: ASR ASR |
$1,263.46
|
| Rate for Payer: ASR Commercial |
$1,263.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.44
|
| Rate for Payer: BCN Commercial |
$1,009.86
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,224.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,302.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.46
|
| Rate for Payer: Mclaren Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.24
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.65 |
| Max. Negotiated Rate |
$1,302.54 |
| Rate for Payer: Aetna Commercial |
$1,172.29
|
| Rate for Payer: ASR ASR |
$1,263.46
|
| Rate for Payer: ASR Commercial |
$1,263.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.44
|
| Rate for Payer: BCN Commercial |
$1,009.86
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,224.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,302.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.46
|
| Rate for Payer: Mclaren Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.24
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,302.54
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,302.54 |
| Rate for Payer: Aetna Commercial |
$1,172.29
|
| Rate for Payer: Aetna Medicare |
$651.27
|
| Rate for Payer: ASR ASR |
$1,263.46
|
| Rate for Payer: ASR Commercial |
$1,263.46
|
| Rate for Payer: BCBS Complete |
$521.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.65
|
| Rate for Payer: BCN Commercial |
$1,009.86
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,224.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,302.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.46
|
| Rate for Payer: Mclaren Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.99
|
| Rate for Payer: Priority Health Narrow Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.24
|
|
