|
HC US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.72
|
| Rate for Payer: BCN Commercial |
$408.72
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$405.53
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$324.42
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.79 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Trust/PPO |
$407.09
|
| Rate for Payer: BCN Commercial |
$407.09
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
IP
|
$440.41
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.31 |
| Max. Negotiated Rate |
$440.41 |
| Rate for Payer: Aetna Commercial |
$396.37
|
| Rate for Payer: ASR ASR |
$427.20
|
| Rate for Payer: BCBS Trust/PPO |
$361.66
|
| Rate for Payer: BCN Commercial |
$361.66
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cofinity Commercial |
$413.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.33
|
| Rate for Payer: Healthscope Commercial |
$427.20
|
| Rate for Payer: Healthscope Whirlpool |
$440.41
|
| Rate for Payer: Mclaren Commercial |
$396.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.35
|
| Rate for Payer: Nomi Health Commercial |
$361.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.56
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
OP
|
$440.41
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$162.95 |
| Max. Negotiated Rate |
$440.41 |
| Rate for Payer: Aetna Commercial |
$396.37
|
| Rate for Payer: Aetna Medicare |
$162.95
|
| Rate for Payer: ASR ASR |
$427.20
|
| Rate for Payer: BCBS Complete |
$176.16
|
| Rate for Payer: BCBS Trust/PPO |
$363.12
|
| Rate for Payer: BCN Commercial |
$363.12
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cofinity Commercial |
$413.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.33
|
| Rate for Payer: Healthscope Commercial |
$427.20
|
| Rate for Payer: Healthscope Whirlpool |
$440.41
|
| Rate for Payer: Mclaren Commercial |
$396.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.35
|
| Rate for Payer: Nomi Health Commercial |
$361.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$394.03
|
| Rate for Payer: Priority Health Narrow Network |
$315.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.56
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
OP
|
$362.55
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.14 |
| Max. Negotiated Rate |
$394.03 |
| Rate for Payer: Aetna Commercial |
$326.30
|
| Rate for Payer: Aetna Medicare |
$134.14
|
| Rate for Payer: ASR ASR |
$351.67
|
| Rate for Payer: BCBS Complete |
$145.02
|
| Rate for Payer: BCBS Trust/PPO |
$298.92
|
| Rate for Payer: BCN Commercial |
$298.92
|
| Rate for Payer: Cash Price |
$290.04
|
| Rate for Payer: Cash Price |
$290.04
|
| Rate for Payer: Cofinity Commercial |
$340.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.04
|
| Rate for Payer: Healthscope Commercial |
$351.67
|
| Rate for Payer: Healthscope Whirlpool |
$362.55
|
| Rate for Payer: Mclaren Commercial |
$326.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.17
|
| Rate for Payer: Nomi Health Commercial |
$297.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$394.03
|
| Rate for Payer: Priority Health Narrow Network |
$315.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.04
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
IP
|
$362.55
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Aetna Commercial |
$326.30
|
| Rate for Payer: ASR ASR |
$351.67
|
| Rate for Payer: BCBS Trust/PPO |
$297.73
|
| Rate for Payer: BCN Commercial |
$297.73
|
| Rate for Payer: Cash Price |
$290.04
|
| Rate for Payer: Cofinity Commercial |
$340.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.04
|
| Rate for Payer: Healthscope Commercial |
$351.67
|
| Rate for Payer: Healthscope Whirlpool |
$362.55
|
| Rate for Payer: Mclaren Commercial |
$326.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.17
|
| Rate for Payer: Nomi Health Commercial |
$297.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.04
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
OP
|
$212.24
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$212.24 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$205.87
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$174.99
|
| Rate for Payer: BCCCP Commercial |
$86.41
|
| Rate for Payer: BCN Commercial |
$174.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Commercial |
$199.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$205.87
|
| Rate for Payer: Healthscope Whirlpool |
$212.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$191.02
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Nomi Health Commercial |
$174.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$113.62
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
IP
|
$212.24
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.18 |
| Max. Negotiated Rate |
$212.24 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: ASR ASR |
$205.87
|
| Rate for Payer: BCBS Trust/PPO |
$174.29
|
| Rate for Payer: BCN Commercial |
$174.29
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Commercial |
$199.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$205.87
|
| Rate for Payer: Healthscope Whirlpool |
$212.24
|
| Rate for Payer: Mclaren Commercial |
$191.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Nomi Health Commercial |
$174.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.77
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
OP
|
$316.20
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$316.20 |
| Rate for Payer: Aetna Commercial |
$284.58
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$306.71
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$260.71
|
| Rate for Payer: BCCCP Commercial |
$86.41
|
| Rate for Payer: BCN Commercial |
$260.71
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cofinity Commercial |
$297.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$306.71
|
| Rate for Payer: Healthscope Whirlpool |
$316.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$284.58
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.77
|
| Rate for Payer: Nomi Health Commercial |
$259.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.15
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$113.62
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
IP
|
$316.20
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$237.15 |
| Max. Negotiated Rate |
$316.20 |
| Rate for Payer: Aetna Commercial |
$284.58
|
| Rate for Payer: ASR ASR |
$306.71
|
| Rate for Payer: BCBS Trust/PPO |
$259.66
|
| Rate for Payer: BCN Commercial |
$259.66
|
| Rate for Payer: Cash Price |
$252.96
|
| Rate for Payer: Cofinity Commercial |
$297.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.96
|
| Rate for Payer: Healthscope Commercial |
$306.71
|
| Rate for Payer: Healthscope Whirlpool |
$316.20
|
| Rate for Payer: Mclaren Commercial |
$284.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.77
|
| Rate for Payer: Nomi Health Commercial |
$259.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.26
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$43.22 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.22
|
| Rate for Payer: Priority Health Narrow Network |
$34.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
IP
|
$214.20
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: ASR ASR |
$207.77
|
| Rate for Payer: BCBS Trust/PPO |
$175.90
|
| Rate for Payer: BCN Commercial |
$175.90
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$207.77
|
| Rate for Payer: Healthscope Whirlpool |
$214.20
|
| Rate for Payer: Mclaren Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.50
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
OP
|
$214.20
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: Aetna Medicare |
$79.25
|
| Rate for Payer: ASR ASR |
$207.77
|
| Rate for Payer: BCBS Complete |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$176.61
|
| Rate for Payer: BCN Commercial |
$176.61
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$207.77
|
| Rate for Payer: Healthscope Whirlpool |
$214.20
|
| Rate for Payer: Mclaren Commercial |
$192.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.22
|
| Rate for Payer: Priority Health Narrow Network |
$34.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.50
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$293.76
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: ASR ASR |
$284.95
|
| Rate for Payer: BCBS Trust/PPO |
$241.24
|
| Rate for Payer: BCN Commercial |
$241.24
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Commercial |
$276.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Healthscope Commercial |
$284.95
|
| Rate for Payer: Healthscope Whirlpool |
$293.76
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.51
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$293.76
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$284.95
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$242.21
|
| Rate for Payer: BCN Commercial |
$242.21
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Commercial |
$276.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$284.95
|
| Rate for Payer: Healthscope Whirlpool |
$293.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$113.62
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$482.62
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$361.96 |
| Max. Negotiated Rate |
$482.62 |
| Rate for Payer: Aetna Commercial |
$434.36
|
| Rate for Payer: ASR ASR |
$468.14
|
| Rate for Payer: BCBS Trust/PPO |
$396.33
|
| Rate for Payer: BCN Commercial |
$396.33
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cofinity Commercial |
$453.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.10
|
| Rate for Payer: Healthscope Commercial |
$468.14
|
| Rate for Payer: Healthscope Whirlpool |
$482.62
|
| Rate for Payer: Mclaren Commercial |
$434.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.23
|
| Rate for Payer: Nomi Health Commercial |
$395.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.71
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$482.62
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$178.57 |
| Max. Negotiated Rate |
$482.62 |
| Rate for Payer: Aetna Commercial |
$434.36
|
| Rate for Payer: Aetna Medicare |
$178.57
|
| Rate for Payer: ASR ASR |
$468.14
|
| Rate for Payer: BCBS Complete |
$193.05
|
| Rate for Payer: BCBS Trust/PPO |
$397.92
|
| Rate for Payer: BCN Commercial |
$397.92
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cofinity Commercial |
$453.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.10
|
| Rate for Payer: Healthscope Commercial |
$468.14
|
| Rate for Payer: Healthscope Whirlpool |
$482.62
|
| Rate for Payer: Mclaren Commercial |
$434.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.23
|
| Rate for Payer: Nomi Health Commercial |
$395.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$422.87
|
| Rate for Payer: Priority Health Narrow Network |
$338.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.71
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$700.75
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.56 |
| Max. Negotiated Rate |
$700.75 |
| Rate for Payer: Aetna Commercial |
$630.67
|
| Rate for Payer: ASR ASR |
$679.73
|
| Rate for Payer: BCBS Trust/PPO |
$575.46
|
| Rate for Payer: BCN Commercial |
$575.46
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Commercial |
$658.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Healthscope Commercial |
$679.73
|
| Rate for Payer: Healthscope Whirlpool |
$700.75
|
| Rate for Payer: Mclaren Commercial |
$630.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$574.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.66
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$700.75
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$700.75 |
| Rate for Payer: Aetna Commercial |
$630.67
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$679.73
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$577.77
|
| Rate for Payer: BCCCP Commercial |
$60.92
|
| Rate for Payer: BCN Commercial |
$577.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Commercial |
$658.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$679.73
|
| Rate for Payer: Healthscope Whirlpool |
$700.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$630.67
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$574.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$315.96
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$252.76
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$700.75
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.56 |
| Max. Negotiated Rate |
$700.75 |
| Rate for Payer: Aetna Commercial |
$630.67
|
| Rate for Payer: ASR ASR |
$679.73
|
| Rate for Payer: BCBS Trust/PPO |
$575.46
|
| Rate for Payer: BCN Commercial |
$575.46
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Commercial |
$658.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Healthscope Commercial |
$679.73
|
| Rate for Payer: Healthscope Whirlpool |
$700.75
|
| Rate for Payer: Mclaren Commercial |
$630.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$574.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.66
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$700.75
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$700.75 |
| Rate for Payer: Aetna Commercial |
$630.67
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$679.73
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$577.77
|
| Rate for Payer: BCN Commercial |
$577.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Commercial |
$658.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$679.73
|
| Rate for Payer: Healthscope Whirlpool |
$700.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$630.67
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$574.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$614.00
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$491.23
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,236.73
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$927.55 |
| Max. Negotiated Rate |
$1,236.73 |
| Rate for Payer: Aetna Commercial |
$1,113.06
|
| Rate for Payer: ASR ASR |
$1,199.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.60
|
| Rate for Payer: BCN Commercial |
$1,015.60
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cofinity Commercial |
$1,162.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.38
|
| Rate for Payer: Healthscope Commercial |
$1,199.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,236.73
|
| Rate for Payer: Mclaren Commercial |
$1,113.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.22
|
| Rate for Payer: Nomi Health Commercial |
$1,014.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,088.32
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,236.73
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,236.73 |
| Rate for Payer: Aetna Commercial |
$1,113.06
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,199.63
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.68
|
| Rate for Payer: BCN Commercial |
$1,019.68
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cofinity Commercial |
$1,162.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,199.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,236.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,113.06
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.22
|
| Rate for Payer: Nomi Health Commercial |
$1,014.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.55
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$330.49
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$264.39
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,088.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,473.59
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,855.19 |
| Max. Negotiated Rate |
$2,473.59 |
| Rate for Payer: Aetna Commercial |
$2,226.23
|
| Rate for Payer: ASR ASR |
$2,399.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.31
|
| Rate for Payer: BCN Commercial |
$2,031.31
|
| Rate for Payer: Cash Price |
$1,978.87
|
| Rate for Payer: Cofinity Commercial |
$2,325.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,978.87
|
| Rate for Payer: Healthscope Commercial |
$2,399.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.59
|
| Rate for Payer: Mclaren Commercial |
$2,226.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,102.55
|
| Rate for Payer: Nomi Health Commercial |
$2,028.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,176.76
|
|
