|
HC SODIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.71
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.58
|
| Rate for Payer: Mclaren Medicare |
$4.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: Meridian Medicaid |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$5.29
|
| Rate for Payer: PHP Medicaid |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.81
|
| Rate for Payer: UHC Exchange |
$7.46
|
| Rate for Payer: UHC Medicare Advantage |
$4.81
|
| Rate for Payer: UHCCP DNSP |
$4.81
|
| Rate for Payer: UHCCP Medicaid |
$2.58
|
| Rate for Payer: VA VA |
$4.81
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: ASR Commercial |
$20.99
|
| Rate for Payer: BCBS Complete |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.72
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.86
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$2.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: PACE Medicare |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.35
|
| Rate for Payer: PHP Medicaid |
$2.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health Narrow Network |
$15.17
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.86
|
| Rate for Payer: UHC Exchange |
$7.53
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: UHCCP DNSP |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$2.60
|
| Rate for Payer: VA VA |
$4.86
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: ASR Commercial |
$20.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.99
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$35.19 |
| Rate for Payer: Aetna Commercial |
$31.67
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.33
|
| Rate for Payer: ASR ASR |
$34.13
|
| Rate for Payer: ASR Commercial |
$34.13
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$28.82
|
| Rate for Payer: BCN Commercial |
$27.28
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Whirlpool |
$34.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.06
|
| Rate for Payer: Mclaren Commercial |
$31.67
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: Meridian Medicaid |
$2.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Nomi Health Commercial |
$28.86
|
| Rate for Payer: PACE Medicare |
$4.81
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$5.57
|
| Rate for Payer: PHP Medicaid |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.83
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health Narrow Network |
$24.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.06
|
| Rate for Payer: UHC Exchange |
$7.84
|
| Rate for Payer: UHC Medicare Advantage |
$5.06
|
| Rate for Payer: UHCCP DNSP |
$5.06
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.06
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$35.19 |
| Rate for Payer: Aetna Commercial |
$31.67
|
| Rate for Payer: ASR ASR |
$34.13
|
| Rate for Payer: ASR Commercial |
$34.13
|
| Rate for Payer: BCBS Trust/PPO |
$28.68
|
| Rate for Payer: BCN Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Whirlpool |
$34.13
|
| Rate for Payer: Mclaren Commercial |
$31.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Nomi Health Commercial |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.97
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$175.67
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: ASR ASR |
$189.33
|
| Rate for Payer: ASR Commercial |
$189.33
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS Trust/PPO |
$159.84
|
| Rate for Payer: BCN Commercial |
$151.33
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Healthscope Commercial |
$195.19
|
| Rate for Payer: Healthscope Whirlpool |
$189.33
|
| Rate for Payer: Mclaren Commercial |
$175.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.03
|
| Rate for Payer: Priority Health Narrow Network |
$136.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.77
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$175.67
|
| Rate for Payer: ASR ASR |
$189.33
|
| Rate for Payer: ASR Commercial |
$189.33
|
| Rate for Payer: BCBS Trust/PPO |
$159.06
|
| Rate for Payer: BCN Commercial |
$151.33
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Healthscope Commercial |
$195.19
|
| Rate for Payer: Healthscope Whirlpool |
$189.33
|
| Rate for Payer: Mclaren Commercial |
$175.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.77
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$161.54 |
| Rate for Payer: Aetna Commercial |
$145.39
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: ASR ASR |
$156.69
|
| Rate for Payer: ASR Commercial |
$156.69
|
| Rate for Payer: BCBS Complete |
$64.62
|
| Rate for Payer: BCBS Trust/PPO |
$132.29
|
| Rate for Payer: BCN Commercial |
$125.24
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$151.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$161.54
|
| Rate for Payer: Healthscope Whirlpool |
$156.69
|
| Rate for Payer: Mclaren Commercial |
$145.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: Nomi Health Commercial |
$132.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.54
|
| Rate for Payer: Priority Health Narrow Network |
$113.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.16
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$161.54 |
| Rate for Payer: Aetna Commercial |
$145.39
|
| Rate for Payer: ASR ASR |
$156.69
|
| Rate for Payer: ASR Commercial |
$156.69
|
| Rate for Payer: BCBS Trust/PPO |
$131.64
|
| Rate for Payer: BCN Commercial |
$125.24
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$151.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$161.54
|
| Rate for Payer: Healthscope Whirlpool |
$156.69
|
| Rate for Payer: Mclaren Commercial |
$145.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: Nomi Health Commercial |
$132.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.16
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$215.28
|
| Rate for Payer: Aetna Medicare |
$119.60
|
| Rate for Payer: ASR ASR |
$232.02
|
| Rate for Payer: ASR Commercial |
$232.02
|
| Rate for Payer: BCBS Complete |
$95.68
|
| Rate for Payer: BCBS Trust/PPO |
$195.88
|
| Rate for Payer: BCN Commercial |
$185.45
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$224.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Healthscope Commercial |
$239.20
|
| Rate for Payer: Healthscope Whirlpool |
$232.02
|
| Rate for Payer: Mclaren Commercial |
$215.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: Nomi Health Commercial |
$196.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.59
|
| Rate for Payer: Priority Health Narrow Network |
$167.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.50
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$215.28
|
| Rate for Payer: ASR ASR |
$232.02
|
| Rate for Payer: ASR Commercial |
$232.02
|
| Rate for Payer: BCBS Trust/PPO |
$194.92
|
| Rate for Payer: BCN Commercial |
$185.45
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$224.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Healthscope Commercial |
$239.20
|
| Rate for Payer: Healthscope Whirlpool |
$232.02
|
| Rate for Payer: Mclaren Commercial |
$215.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: Nomi Health Commercial |
$196.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.50
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: ASR ASR |
$58.03
|
| Rate for Payer: ASR Commercial |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$48.75
|
| Rate for Payer: BCN Commercial |
$46.38
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$59.82
|
| Rate for Payer: Healthscope Whirlpool |
$58.03
|
| Rate for Payer: Mclaren Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.64
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$36.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.71
|
| Rate for Payer: ASR ASR |
$58.03
|
| Rate for Payer: ASR Commercial |
$58.03
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS MAPPO |
$36.57
|
| Rate for Payer: BCBS Trust/PPO |
$48.99
|
| Rate for Payer: BCN Commercial |
$46.38
|
| Rate for Payer: BCN Medicare Advantage |
$36.57
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$59.82
|
| Rate for Payer: Healthscope Whirlpool |
$58.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$36.57
|
| Rate for Payer: Mclaren Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| Rate for Payer: Mclaren Medicare |
$36.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: PACE Medicare |
$34.74
|
| Rate for Payer: PACE SWMI |
$36.57
|
| Rate for Payer: PHP Commercial |
$40.23
|
| Rate for Payer: PHP Medicaid |
$19.60
|
| Rate for Payer: PHP Medicare Advantage |
$36.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.41
|
| Rate for Payer: Priority Health Medicare |
$36.57
|
| Rate for Payer: Priority Health Narrow Network |
$41.93
|
| Rate for Payer: Railroad Medicare Medicare |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.57
|
| Rate for Payer: UHC Exchange |
$56.68
|
| Rate for Payer: UHC Medicare Advantage |
$36.57
|
| Rate for Payer: UHCCP DNSP |
$36.57
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: VA VA |
$36.57
|
|
|
HC SOMATOMEDIN
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: ASR ASR |
$53.49
|
| Rate for Payer: ASR Commercial |
$53.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.93
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$55.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Mclaren Commercial |
$49.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.52
|
|
|
HC SOMATOMEDIN
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: Aetna Medicare |
$21.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.57
|
| Rate for Payer: ASR ASR |
$53.49
|
| Rate for Payer: ASR Commercial |
$53.49
|
| Rate for Payer: BCBS Complete |
$11.97
|
| Rate for Payer: BCBS MAPPO |
$21.26
|
| Rate for Payer: BCBS Trust/PPO |
$45.15
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$21.26
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$55.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.26
|
| Rate for Payer: Mclaren Commercial |
$49.63
|
| Rate for Payer: Mclaren Medicaid |
$11.40
|
| Rate for Payer: Mclaren Medicare |
$21.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.32
|
| Rate for Payer: Meridian Medicaid |
$11.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PACE Medicare |
$20.20
|
| Rate for Payer: PACE SWMI |
$21.26
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Medicaid |
$11.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.31
|
| Rate for Payer: Priority Health Medicare |
$21.26
|
| Rate for Payer: Priority Health Narrow Network |
$38.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.26
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHC Medicare Advantage |
$21.26
|
| Rate for Payer: UHCCP DNSP |
$21.26
|
| Rate for Payer: UHCCP Medicaid |
$11.40
|
| Rate for Payer: VA VA |
$21.26
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
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 SOYBEAN IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,419.44 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: Aetna Medicare |
$3,024.30
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: ASR Commercial |
$5,867.14
|
| Rate for Payer: BCBS Complete |
$2,419.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,953.20
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,299.78
|
| Rate for Payer: Priority Health Narrow Network |
$4,240.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,931.59 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: ASR Commercial |
$5,867.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,929.00
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,152.34
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,372.91
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,698.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,849.48 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.94
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
IP
|
$3,982.07
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.35 |
| Max. Negotiated Rate |
$3,982.07 |
| Rate for Payer: Aetna Commercial |
$3,583.86
|
| Rate for Payer: ASR ASR |
$3,862.61
|
| Rate for Payer: ASR Commercial |
$3,862.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,244.99
|
| Rate for Payer: BCN Commercial |
$3,087.30
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cofinity Commercial |
$3,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,185.66
|
| Rate for Payer: Healthscope Commercial |
$3,982.07
|
| Rate for Payer: Healthscope Whirlpool |
$3,862.61
|
| Rate for Payer: Mclaren Commercial |
$3,583.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,384.76
|
| Rate for Payer: Nomi Health Commercial |
$3,265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,588.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,504.22
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
OP
|
$3,982.07
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,583.86
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,862.61
|
| Rate for Payer: ASR Commercial |
$3,862.61
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,260.92
|
| Rate for Payer: BCN Commercial |
$3,087.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cofinity Commercial |
$3,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,185.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,982.07
|
| Rate for Payer: Healthscope Whirlpool |
$3,862.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,583.86
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,384.76
|
| Rate for Payer: Nomi Health Commercial |
$3,265.30
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,588.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,489.09
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,791.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,504.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
IP
|
$3,266.13
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,122.98 |
| Max. Negotiated Rate |
$3,266.13 |
| Rate for Payer: Aetna Commercial |
$2,939.52
|
| Rate for Payer: ASR ASR |
$3,168.15
|
| Rate for Payer: ASR Commercial |
$3,168.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,661.57
|
| Rate for Payer: BCN Commercial |
$2,532.23
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$3,070.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$3,266.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,168.15
|
| Rate for Payer: Mclaren Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$2,678.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,874.19
|
|
