|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,473.59
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$2,473.59 |
| Rate for Payer: Aetna Commercial |
$2,226.23
|
| 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 |
$2,399.38
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.47
|
| Rate for Payer: BCN Commercial |
$2,039.47
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,978.87
|
| 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: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$2,399.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$2,226.23
|
| 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 |
$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: 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 |
$2,176.76
|
| 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 FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$879.73
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$879.73 |
| Rate for Payer: Aetna Commercial |
$791.76
|
| Rate for Payer: ASR ASR |
$853.34
|
| Rate for Payer: BCBS Trust/PPO |
$722.43
|
| Rate for Payer: BCN Commercial |
$722.43
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cofinity Commercial |
$826.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.78
|
| Rate for Payer: Healthscope Commercial |
$853.34
|
| Rate for Payer: Healthscope Whirlpool |
$879.73
|
| Rate for Payer: Mclaren Commercial |
$791.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.77
|
| Rate for Payer: Nomi Health Commercial |
$721.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.16
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$879.73
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$879.73 |
| Rate for Payer: Aetna Commercial |
$791.76
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$853.34
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$725.34
|
| Rate for Payer: BCN Commercial |
$725.34
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cofinity Commercial |
$826.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$853.34
|
| Rate for Payer: Healthscope Whirlpool |
$879.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$791.76
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.77
|
| Rate for Payer: Nomi Health Commercial |
$721.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.80
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$770.82
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$616.69
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Trust/PPO |
$244.45
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| 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 |
$288.75
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.44
|
| Rate for Payer: BCN Commercial |
$245.44
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| 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 |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| 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 |
$260.83
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$208.67
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
| 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 FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| 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 |
$288.75
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.44
|
| Rate for Payer: BCN Commercial |
$245.44
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| 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 |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| 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 |
$158.57
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$126.86
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
| 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 FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Trust/PPO |
$244.45
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$421.63
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$421.63 |
| Rate for Payer: Aetna Commercial |
$379.47
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: ASR ASR |
$408.98
|
| Rate for Payer: BCBS Complete |
$168.65
|
| Rate for Payer: BCBS Trust/PPO |
$347.63
|
| Rate for Payer: BCN Commercial |
$347.63
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cofinity Commercial |
$396.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.30
|
| Rate for Payer: Healthscope Commercial |
$408.98
|
| Rate for Payer: Healthscope Whirlpool |
$421.63
|
| Rate for Payer: Mclaren Commercial |
$379.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.39
|
| Rate for Payer: Nomi Health Commercial |
$345.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$369.43
|
| Rate for Payer: Priority Health Narrow Network |
$295.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.03
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$421.63
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$316.22 |
| Max. Negotiated Rate |
$421.63 |
| Rate for Payer: Aetna Commercial |
$379.47
|
| Rate for Payer: ASR ASR |
$408.98
|
| Rate for Payer: BCBS Trust/PPO |
$346.24
|
| Rate for Payer: BCN Commercial |
$346.24
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cofinity Commercial |
$396.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.30
|
| Rate for Payer: Healthscope Commercial |
$408.98
|
| Rate for Payer: Healthscope Whirlpool |
$421.63
|
| Rate for Payer: Mclaren Commercial |
$379.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.39
|
| Rate for Payer: Nomi Health Commercial |
$345.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.03
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$656.83
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$492.62 |
| Max. Negotiated Rate |
$656.83 |
| Rate for Payer: Aetna Commercial |
$591.15
|
| Rate for Payer: ASR ASR |
$637.13
|
| Rate for Payer: BCBS Trust/PPO |
$539.39
|
| Rate for Payer: BCN Commercial |
$539.39
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cofinity Commercial |
$617.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.46
|
| Rate for Payer: Healthscope Commercial |
$637.13
|
| Rate for Payer: Healthscope Whirlpool |
$656.83
|
| Rate for Payer: Mclaren Commercial |
$591.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.31
|
| Rate for Payer: Nomi Health Commercial |
$538.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.01
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$656.83
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$656.83 |
| Rate for Payer: Aetna Commercial |
$591.15
|
| Rate for Payer: Aetna Medicare |
$243.03
|
| Rate for Payer: ASR ASR |
$637.13
|
| Rate for Payer: BCBS Complete |
$262.73
|
| Rate for Payer: BCBS Trust/PPO |
$541.56
|
| Rate for Payer: BCCCP Commercial |
$55.83
|
| Rate for Payer: BCN Commercial |
$541.56
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cofinity Commercial |
$617.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.46
|
| Rate for Payer: Healthscope Commercial |
$637.13
|
| Rate for Payer: Healthscope Whirlpool |
$656.83
|
| Rate for Payer: Mclaren Commercial |
$591.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.31
|
| Rate for Payer: Nomi Health Commercial |
$538.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.42
|
| Rate for Payer: Priority Health Narrow Network |
$367.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.01
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$387.99 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$387.99
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$310.39
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$401.91 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$401.91
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
OP
|
$330.69
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$330.69 |
| Rate for Payer: Aetna Commercial |
$297.62
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$320.77
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$272.65
|
| Rate for Payer: BCN Commercial |
$272.65
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cofinity Commercial |
$310.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$320.77
|
| Rate for Payer: Healthscope Whirlpool |
$330.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$297.62
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.09
|
| Rate for Payer: Nomi Health Commercial |
$271.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.02
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$289.75
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$231.81
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
IP
|
$330.69
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$248.02 |
| Max. Negotiated Rate |
$330.69 |
| Rate for Payer: Aetna Commercial |
$297.62
|
| Rate for Payer: ASR ASR |
$320.77
|
| Rate for Payer: BCBS Trust/PPO |
$271.56
|
| Rate for Payer: BCN Commercial |
$271.56
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cofinity Commercial |
$310.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.55
|
| Rate for Payer: Healthscope Commercial |
$320.77
|
| Rate for Payer: Healthscope Whirlpool |
$330.69
|
| Rate for Payer: Mclaren Commercial |
$297.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.09
|
| Rate for Payer: Nomi Health Commercial |
$271.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.01
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.48 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$543.60
|
| Rate for Payer: Aetna Medicare |
$223.48
|
| Rate for Payer: ASR ASR |
$585.88
|
| Rate for Payer: BCBS Complete |
$241.60
|
| Rate for Payer: BCBS Trust/PPO |
$498.00
|
| Rate for Payer: BCN Commercial |
$498.00
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$567.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.20
|
| Rate for Payer: Healthscope Commercial |
$585.88
|
| Rate for Payer: Healthscope Whirlpool |
$604.00
|
| Rate for Payer: Mclaren Commercial |
$543.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.40
|
| Rate for Payer: Nomi Health Commercial |
$495.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$453.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.42
|
| Rate for Payer: Priority Health Narrow Network |
$367.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.52
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$453.00 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$543.60
|
| Rate for Payer: ASR ASR |
$585.88
|
| Rate for Payer: BCBS Trust/PPO |
$496.00
|
| Rate for Payer: BCN Commercial |
$496.00
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$567.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.20
|
| Rate for Payer: Healthscope Commercial |
$585.88
|
| Rate for Payer: Healthscope Whirlpool |
$604.00
|
| Rate for Payer: Mclaren Commercial |
$543.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.40
|
| Rate for Payer: Nomi Health Commercial |
$495.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$453.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.52
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
OP
|
$594.95
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.13 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: Aetna Medicare |
$220.13
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Complete |
$237.98
|
| Rate for Payer: BCBS Trust/PPO |
$490.54
|
| Rate for Payer: BCN Commercial |
$490.54
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$475.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$521.30
|
| Rate for Payer: Priority Health Narrow Network |
$417.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
IP
|
$594.95
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.21 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Trust/PPO |
$488.57
|
| Rate for Payer: BCN Commercial |
$488.57
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
|
|
HC US OB BPP WO NON STRESS
|
Facility
|
OP
|
$655.74
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$655.74 |
| Rate for Payer: Aetna Commercial |
$590.17
|
| 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 |
$636.07
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$540.66
|
| Rate for Payer: BCN Commercial |
$540.66
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$524.59
|
| Rate for Payer: Cash Price |
$524.59
|
| Rate for Payer: Cofinity Commercial |
$616.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$636.07
|
| Rate for Payer: Healthscope Whirlpool |
$655.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$590.17
|
| 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 |
$557.38
|
| Rate for Payer: Nomi Health Commercial |
$537.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$491.81
|
| 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 |
$577.05
|
| 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 OB BPP WO NON STRESS
|
Facility
|
IP
|
$655.74
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$491.81 |
| Max. Negotiated Rate |
$655.74 |
| Rate for Payer: Aetna Commercial |
$590.17
|
| Rate for Payer: ASR ASR |
$636.07
|
| Rate for Payer: BCBS Trust/PPO |
$538.49
|
| Rate for Payer: BCN Commercial |
$538.49
|
| Rate for Payer: Cash Price |
$524.59
|
| Rate for Payer: Cofinity Commercial |
$616.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.59
|
| Rate for Payer: Healthscope Commercial |
$636.07
|
| Rate for Payer: Healthscope Whirlpool |
$655.74
|
| Rate for Payer: Mclaren Commercial |
$590.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.38
|
| Rate for Payer: Nomi Health Commercial |
$537.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$491.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.05
|
|
|
HC US OB DETAILED
|
Facility
|
OP
|
$594.95
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$680.94 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$490.54
|
| Rate for Payer: BCN Commercial |
$490.54
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$680.94
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$544.75
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC US OB DETAILED
|
Facility
|
IP
|
$594.95
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.21 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Trust/PPO |
$488.57
|
| Rate for Payer: BCN Commercial |
$488.57
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
|
