|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$147.85 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$177.42
|
| Rate for Payer: ASR ASR |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$161.88
|
| Rate for Payer: BCN Commercial |
$161.88
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$191.22
|
| Rate for Payer: Healthscope Whirlpool |
$197.13
|
| Rate for Payer: Mclaren Commercial |
$177.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.47
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$177.42
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: ASR ASR |
$191.22
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$162.53
|
| Rate for Payer: BCN Commercial |
$162.53
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$191.22
|
| Rate for Payer: Healthscope Whirlpool |
$197.13
|
| Rate for Payer: Mclaren Commercial |
$177.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.47
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$90.05
|
| Rate for Payer: BCN Commercial |
$90.05
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: Aetna Medicare |
$16.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCN Commercial |
$90.41
|
| Rate for Payer: BCN Medicare Advantage |
$16.13
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.13
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$16.13
|
| Rate for Payer: Mclaren Medicare |
$16.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.13
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: PHP Medicaid |
$8.65
|
| Rate for Payer: PHP Medicare Advantage |
$16.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.06
|
| Rate for Payer: Priority Health Medicare |
$16.13
|
| Rate for Payer: Priority Health Narrow Network |
$78.45
|
| Rate for Payer: Railroad Medicare Medicare |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.13
|
| Rate for Payer: UHC Exchange |
$25.00
|
| Rate for Payer: UHC Medicaid |
$8.44
|
| Rate for Payer: UHCCP DNSP |
$16.13
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$16.13
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| 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 |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,040.41 |
| Max. Negotiated Rate |
$6,047.09 |
| Rate for Payer: Aetna Commercial |
$4,343.78
|
| Rate for Payer: Aetna Medicare |
$3,901.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: ASR ASR |
$4,681.63
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,979.38
|
| Rate for Payer: BCN Commercial |
$3,979.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Commercial |
$4,536.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$4,681.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,826.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,901.35
|
| Rate for Payer: Mclaren Commercial |
$4,343.78
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$2,142.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Nomi Health Commercial |
$3,957.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$4,291.48
|
| Rate for Payer: PHP Medicaid |
$2,091.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,228.91
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Narrow Network |
$3,383.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,247.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Exchange |
$6,047.09
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP DNSP |
$3,901.35
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,619.82 |
| Max. Negotiated Rate |
$4,826.42 |
| Rate for Payer: Aetna Commercial |
$4,343.78
|
| Rate for Payer: ASR ASR |
$4,681.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,963.46
|
| Rate for Payer: BCN Commercial |
$3,963.46
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Commercial |
$4,536.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Healthscope Commercial |
$4,681.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,826.42
|
| Rate for Payer: Mclaren Commercial |
$4,343.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Nomi Health Commercial |
$3,957.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,247.25
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,312.83
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,040.41 |
| Max. Negotiated Rate |
$6,047.09 |
| Rate for Payer: Aetna Commercial |
$2,981.55
|
| Rate for Payer: Aetna Medicare |
$3,901.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: ASR ASR |
$3,213.45
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.43
|
| Rate for Payer: BCN Commercial |
$2,731.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cofinity Commercial |
$3,114.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,650.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$3,213.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,312.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,901.35
|
| Rate for Payer: Mclaren Commercial |
$2,981.55
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$2,142.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.91
|
| Rate for Payer: Nomi Health Commercial |
$2,716.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.62
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$4,291.48
|
| Rate for Payer: PHP Medicaid |
$2,091.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,902.70
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,322.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,915.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Exchange |
$6,047.09
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP DNSP |
$3,901.35
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,312.83
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,484.62 |
| Max. Negotiated Rate |
$3,312.83 |
| Rate for Payer: Aetna Commercial |
$2,981.55
|
| Rate for Payer: ASR ASR |
$3,213.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,720.50
|
| Rate for Payer: BCN Commercial |
$2,720.50
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cofinity Commercial |
$3,114.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,650.26
|
| Rate for Payer: Healthscope Commercial |
$3,213.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,312.83
|
| Rate for Payer: Mclaren Commercial |
$2,981.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.91
|
| Rate for Payer: Nomi Health Commercial |
$2,716.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,915.29
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$48.04
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.05
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$40.84
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
OP
|
$59.79
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$183.99 |
| Rate for Payer: Aetna Commercial |
$53.81
|
| Rate for Payer: Aetna Medicare |
$11.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.90
|
| Rate for Payer: ASR ASR |
$58.00
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS MAPPO |
$11.92
|
| Rate for Payer: BCBS Trust/PPO |
$49.30
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.92
|
| Rate for Payer: Cash Price |
$47.83
|
| Rate for Payer: Cash Price |
$47.83
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.92
|
| Rate for Payer: Healthscope Commercial |
$58.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.92
|
| Rate for Payer: Mclaren Commercial |
$53.81
|
| Rate for Payer: Mclaren Medicaid |
$11.92
|
| Rate for Payer: Mclaren Medicare |
$11.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.52
|
| Rate for Payer: Meridian Medicaid |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.82
|
| Rate for Payer: Nomi Health Commercial |
$49.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.84
|
| Rate for Payer: PACE Medicare |
$11.32
|
| Rate for Payer: PACE SWMI |
$11.92
|
| Rate for Payer: PHP Commercial |
$13.11
|
| Rate for Payer: PHP Medicaid |
$6.39
|
| Rate for Payer: PHP Medicare Advantage |
$11.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$183.99
|
| Rate for Payer: Priority Health Medicare |
$11.92
|
| Rate for Payer: Priority Health Narrow Network |
$147.19
|
| Rate for Payer: Railroad Medicare Medicare |
$11.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.92
|
| Rate for Payer: UHC Exchange |
$18.48
|
| Rate for Payer: UHC Medicaid |
$6.23
|
| Rate for Payer: UHCCP DNSP |
$11.92
|
| Rate for Payer: UHCCP Medicaid |
$6.23
|
| Rate for Payer: VA VA |
$11.92
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
IP
|
$59.79
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Aetna Commercial |
$53.81
|
| Rate for Payer: ASR ASR |
$58.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.10
|
| Rate for Payer: BCN Commercial |
$49.10
|
| Rate for Payer: Cash Price |
$47.83
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.83
|
| Rate for Payer: Healthscope Commercial |
$58.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.79
|
| Rate for Payer: Mclaren Commercial |
$53.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.82
|
| Rate for Payer: Nomi Health Commercial |
$49.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.62
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$56.91 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.91
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$45.53
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$19.35
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.69
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.52
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
