|
HC TRANSFUSION
|
Facility
|
OP
|
$1,196.46
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$1,196.46 |
| Rate for Payer: Aetna Commercial |
$1,076.81
|
| Rate for Payer: Aetna Medicare |
$428.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$535.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$535.42
|
| Rate for Payer: ASR ASR |
$1,160.57
|
| Rate for Payer: ASR Commercial |
$1,160.57
|
| Rate for Payer: BCBS Complete |
$241.07
|
| Rate for Payer: BCBS MAPPO |
$428.34
|
| Rate for Payer: BCBS Trust/PPO |
$979.78
|
| Rate for Payer: BCN Commercial |
$927.62
|
| Rate for Payer: BCN Medicare Advantage |
$428.34
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cofinity Commercial |
$1,124.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.34
|
| Rate for Payer: Healthscope Commercial |
$1,196.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,160.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$428.34
|
| Rate for Payer: Mclaren Commercial |
$1,076.81
|
| Rate for Payer: Mclaren Medicaid |
$229.59
|
| Rate for Payer: Mclaren Medicare |
$428.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.76
|
| Rate for Payer: Meridian Medicaid |
$241.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.99
|
| Rate for Payer: Nomi Health Commercial |
$981.10
|
| Rate for Payer: PACE Medicare |
$406.92
|
| Rate for Payer: PACE SWMI |
$428.34
|
| Rate for Payer: PHP Commercial |
$471.17
|
| Rate for Payer: PHP Medicaid |
$229.59
|
| Rate for Payer: PHP Medicare Advantage |
$428.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$695.05
|
| Rate for Payer: Priority Health Medicare |
$428.34
|
| Rate for Payer: Priority Health Narrow Network |
$556.04
|
| Rate for Payer: Railroad Medicare Medicare |
$428.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,052.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$428.34
|
| Rate for Payer: UHC Exchange |
$663.93
|
| Rate for Payer: UHC Medicare Advantage |
$428.34
|
| Rate for Payer: UHCCP DNSP |
$428.34
|
| Rate for Payer: UHCCP Medicaid |
$229.59
|
| Rate for Payer: VA VA |
$428.34
|
|
|
HC TRANSFUSION
|
Facility
|
IP
|
$1,196.46
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$777.70 |
| Max. Negotiated Rate |
$1,196.46 |
| Rate for Payer: Aetna Commercial |
$1,076.81
|
| Rate for Payer: ASR ASR |
$1,160.57
|
| Rate for Payer: ASR Commercial |
$1,160.57
|
| Rate for Payer: BCBS Trust/PPO |
$975.00
|
| Rate for Payer: BCN Commercial |
$927.62
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cofinity Commercial |
$1,124.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.17
|
| Rate for Payer: Healthscope Commercial |
$1,196.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,160.57
|
| Rate for Payer: Mclaren Commercial |
$1,076.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.99
|
| Rate for Payer: Nomi Health Commercial |
$981.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,052.88
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
IP
|
$632.04
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.83 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$568.84
|
| Rate for Payer: ASR ASR |
$613.08
|
| Rate for Payer: ASR Commercial |
$613.08
|
| Rate for Payer: BCBS Trust/PPO |
$515.05
|
| Rate for Payer: BCN Commercial |
$490.02
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cofinity Commercial |
$594.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.63
|
| Rate for Payer: Healthscope Commercial |
$632.04
|
| Rate for Payer: Healthscope Whirlpool |
$613.08
|
| Rate for Payer: Mclaren Commercial |
$568.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.23
|
| Rate for Payer: Nomi Health Commercial |
$518.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.20
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
OP
|
$632.04
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$663.93 |
| Rate for Payer: Aetna Commercial |
$568.84
|
| Rate for Payer: Aetna Medicare |
$428.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$535.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$535.42
|
| Rate for Payer: ASR ASR |
$613.08
|
| Rate for Payer: ASR Commercial |
$613.08
|
| Rate for Payer: BCBS Complete |
$241.07
|
| Rate for Payer: BCBS MAPPO |
$428.34
|
| Rate for Payer: BCBS Trust/PPO |
$517.58
|
| Rate for Payer: BCN Commercial |
$490.02
|
| Rate for Payer: BCN Medicare Advantage |
$428.34
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cofinity Commercial |
$594.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.34
|
| Rate for Payer: Healthscope Commercial |
$632.04
|
| Rate for Payer: Healthscope Whirlpool |
$613.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$428.34
|
| Rate for Payer: Mclaren Commercial |
$568.84
|
| Rate for Payer: Mclaren Medicaid |
$229.59
|
| Rate for Payer: Mclaren Medicare |
$428.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.76
|
| Rate for Payer: Meridian Medicaid |
$241.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.23
|
| Rate for Payer: Nomi Health Commercial |
$518.27
|
| Rate for Payer: PACE Medicare |
$406.92
|
| Rate for Payer: PACE SWMI |
$428.34
|
| Rate for Payer: PHP Commercial |
$471.17
|
| Rate for Payer: PHP Medicaid |
$229.59
|
| Rate for Payer: PHP Medicare Advantage |
$428.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.79
|
| Rate for Payer: Priority Health Medicare |
$428.34
|
| Rate for Payer: Priority Health Narrow Network |
$443.06
|
| Rate for Payer: Railroad Medicare Medicare |
$428.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$428.34
|
| Rate for Payer: UHC Exchange |
$663.93
|
| Rate for Payer: UHC Medicare Advantage |
$428.34
|
| Rate for Payer: UHCCP DNSP |
$428.34
|
| Rate for Payer: UHCCP Medicaid |
$229.59
|
| Rate for Payer: VA VA |
$428.34
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
OP
|
$3,168.13
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$2,851.32
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,073.09
|
| Rate for Payer: ASR Commercial |
$3,073.09
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,594.38
|
| Rate for Payer: BCN Commercial |
$2,456.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cofinity Commercial |
$2,978.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,534.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,168.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,073.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$2,851.32
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,692.91
|
| Rate for Payer: Nomi Health Commercial |
$2,597.87
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,775.92
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,220.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,787.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
IP
|
$3,168.13
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,059.28 |
| Max. Negotiated Rate |
$3,168.13 |
| Rate for Payer: Aetna Commercial |
$2,851.32
|
| Rate for Payer: ASR ASR |
$3,073.09
|
| Rate for Payer: ASR Commercial |
$3,073.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.71
|
| Rate for Payer: BCN Commercial |
$2,456.25
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cofinity Commercial |
$2,978.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,534.50
|
| Rate for Payer: Healthscope Commercial |
$3,168.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,073.09
|
| Rate for Payer: Mclaren Commercial |
$2,851.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,692.91
|
| Rate for Payer: Nomi Health Commercial |
$2,597.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,787.95
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
IP
|
$6,252.80
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,064.32 |
| Max. Negotiated Rate |
$6,252.80 |
| Rate for Payer: Aetna Commercial |
$5,627.52
|
| Rate for Payer: ASR ASR |
$6,065.22
|
| Rate for Payer: ASR Commercial |
$6,065.22
|
| Rate for Payer: BCBS Trust/PPO |
$5,095.41
|
| Rate for Payer: BCN Commercial |
$4,847.80
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cofinity Commercial |
$5,877.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,002.24
|
| Rate for Payer: Healthscope Commercial |
$6,252.80
|
| Rate for Payer: Healthscope Whirlpool |
$6,065.22
|
| Rate for Payer: Mclaren Commercial |
$5,627.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,314.88
|
| Rate for Payer: Nomi Health Commercial |
$5,127.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,064.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,502.46
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
OP
|
$6,252.80
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,669.72 |
| Max. Negotiated Rate |
$7,720.29 |
| Rate for Payer: Aetna Commercial |
$5,627.52
|
| Rate for Payer: Aetna Medicare |
$4,980.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: ASR ASR |
$6,065.22
|
| Rate for Payer: ASR Commercial |
$6,065.22
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,120.42
|
| Rate for Payer: BCN Commercial |
$4,847.80
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cofinity Commercial |
$5,877.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Healthscope Commercial |
$6,252.80
|
| Rate for Payer: Healthscope Whirlpool |
$6,065.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,980.83
|
| Rate for Payer: Mclaren Commercial |
$5,627.52
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,314.88
|
| Rate for Payer: Nomi Health Commercial |
$5,127.30
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Commercial |
$5,478.91
|
| Rate for Payer: PHP Medicaid |
$2,669.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,064.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,242.73
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,394.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,502.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$7,720.29
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP DNSP |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
OP
|
$3,693.55
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,477.42 |
| Max. Negotiated Rate |
$3,693.55 |
| Rate for Payer: Aetna Commercial |
$3,324.20
|
| Rate for Payer: Aetna Medicare |
$1,846.78
|
| Rate for Payer: ASR ASR |
$3,582.74
|
| Rate for Payer: ASR Commercial |
$3,582.74
|
| Rate for Payer: BCBS Complete |
$1,477.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,024.65
|
| Rate for Payer: BCN Commercial |
$2,863.61
|
| Rate for Payer: Cash Price |
$2,954.84
|
| Rate for Payer: Cofinity Commercial |
$3,471.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.84
|
| Rate for Payer: Healthscope Commercial |
$3,693.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.74
|
| Rate for Payer: Mclaren Commercial |
$3,324.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.52
|
| Rate for Payer: Nomi Health Commercial |
$3,028.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,400.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,236.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,589.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.32
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
IP
|
$3,693.55
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,400.81 |
| Max. Negotiated Rate |
$3,693.55 |
| Rate for Payer: Aetna Commercial |
$3,324.20
|
| Rate for Payer: ASR ASR |
$3,582.74
|
| Rate for Payer: ASR Commercial |
$3,582.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,009.87
|
| Rate for Payer: BCN Commercial |
$2,863.61
|
| Rate for Payer: Cash Price |
$2,954.84
|
| Rate for Payer: Cofinity Commercial |
$3,471.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.84
|
| Rate for Payer: Healthscope Commercial |
$3,693.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.74
|
| Rate for Payer: Mclaren Commercial |
$3,324.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.52
|
| Rate for Payer: Nomi Health Commercial |
$3,028.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,400.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.32
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
OP
|
$4,922.93
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,969.17 |
| Max. Negotiated Rate |
$4,922.93 |
| Rate for Payer: Aetna Commercial |
$4,430.64
|
| Rate for Payer: Aetna Medicare |
$2,461.46
|
| Rate for Payer: ASR ASR |
$4,775.24
|
| Rate for Payer: ASR Commercial |
$4,775.24
|
| Rate for Payer: BCBS Complete |
$1,969.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,031.39
|
| Rate for Payer: BCN Commercial |
$3,816.75
|
| Rate for Payer: Cash Price |
$3,938.34
|
| Rate for Payer: Cofinity Commercial |
$4,627.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.34
|
| Rate for Payer: Healthscope Commercial |
$4,922.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,775.24
|
| Rate for Payer: Mclaren Commercial |
$4,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.49
|
| Rate for Payer: Nomi Health Commercial |
$4,036.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,313.47
|
| Rate for Payer: Priority Health Narrow Network |
$3,450.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,332.18
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
IP
|
$4,922.93
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,199.90 |
| Max. Negotiated Rate |
$4,922.93 |
| Rate for Payer: Aetna Commercial |
$4,430.64
|
| Rate for Payer: ASR ASR |
$4,775.24
|
| Rate for Payer: ASR Commercial |
$4,775.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,011.70
|
| Rate for Payer: BCN Commercial |
$3,816.75
|
| Rate for Payer: Cash Price |
$3,938.34
|
| Rate for Payer: Cofinity Commercial |
$4,627.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.34
|
| Rate for Payer: Healthscope Commercial |
$4,922.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,775.24
|
| Rate for Payer: Mclaren Commercial |
$4,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.49
|
| Rate for Payer: Nomi Health Commercial |
$4,036.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,332.18
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
OP
|
$904.39
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.76 |
| Max. Negotiated Rate |
$904.39 |
| Rate for Payer: Aetna Commercial |
$813.95
|
| Rate for Payer: Aetna Medicare |
$452.20
|
| Rate for Payer: ASR ASR |
$877.26
|
| Rate for Payer: ASR Commercial |
$877.26
|
| Rate for Payer: BCBS Complete |
$361.76
|
| Rate for Payer: BCBS Trust/PPO |
$740.60
|
| Rate for Payer: BCN Commercial |
$701.17
|
| Rate for Payer: Cash Price |
$723.51
|
| Rate for Payer: Cofinity Commercial |
$850.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.51
|
| Rate for Payer: Healthscope Commercial |
$904.39
|
| Rate for Payer: Healthscope Whirlpool |
$877.26
|
| Rate for Payer: Mclaren Commercial |
$813.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.73
|
| Rate for Payer: Nomi Health Commercial |
$741.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$792.43
|
| Rate for Payer: Priority Health Narrow Network |
$633.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.86
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
IP
|
$904.39
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.85 |
| Max. Negotiated Rate |
$904.39 |
| Rate for Payer: Aetna Commercial |
$813.95
|
| Rate for Payer: ASR ASR |
$877.26
|
| Rate for Payer: ASR Commercial |
$877.26
|
| Rate for Payer: BCBS Trust/PPO |
$736.99
|
| Rate for Payer: BCN Commercial |
$701.17
|
| Rate for Payer: Cash Price |
$723.51
|
| Rate for Payer: Cofinity Commercial |
$850.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.51
|
| Rate for Payer: Healthscope Commercial |
$904.39
|
| Rate for Payer: Healthscope Whirlpool |
$877.26
|
| Rate for Payer: Mclaren Commercial |
$813.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.73
|
| Rate for Payer: Nomi Health Commercial |
$741.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.86
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
OP
|
$1,606.50
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: Aetna Medicare |
$803.25
|
| Rate for Payer: ASR ASR |
$1,558.30
|
| Rate for Payer: ASR Commercial |
$1,558.30
|
| Rate for Payer: BCBS Complete |
$642.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.56
|
| Rate for Payer: BCN Commercial |
$1,245.52
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,510.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,606.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.30
|
| Rate for Payer: Mclaren Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.52
|
| Rate for Payer: Nomi Health Commercial |
$1,317.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,407.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,413.72
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
IP
|
$1,606.50
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,044.22 |
| Max. Negotiated Rate |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: ASR ASR |
$1,558.30
|
| Rate for Payer: ASR Commercial |
$1,558.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.14
|
| Rate for Payer: BCN Commercial |
$1,245.52
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,510.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,606.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.30
|
| Rate for Payer: Mclaren Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.52
|
| Rate for Payer: Nomi Health Commercial |
$1,317.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,413.72
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
OP
|
$1,194.38
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,194.38 |
| Rate for Payer: Aetna Commercial |
$1,074.94
|
| Rate for Payer: Aetna Medicare |
$597.19
|
| Rate for Payer: ASR ASR |
$1,158.55
|
| Rate for Payer: ASR Commercial |
$1,158.55
|
| Rate for Payer: BCBS Complete |
$477.75
|
| Rate for Payer: BCBS Trust/PPO |
$978.08
|
| Rate for Payer: BCN Commercial |
$926.00
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cofinity Commercial |
$1,122.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$955.50
|
| Rate for Payer: Healthscope Commercial |
$1,194.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,158.55
|
| Rate for Payer: Mclaren Commercial |
$1,074.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.22
|
| Rate for Payer: Nomi Health Commercial |
$979.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,046.52
|
| Rate for Payer: Priority Health Narrow Network |
$837.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.05
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
IP
|
$1,194.38
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$776.35 |
| Max. Negotiated Rate |
$1,194.38 |
| Rate for Payer: Aetna Commercial |
$1,074.94
|
| Rate for Payer: ASR ASR |
$1,158.55
|
| Rate for Payer: ASR Commercial |
$1,158.55
|
| Rate for Payer: BCBS Trust/PPO |
$973.30
|
| Rate for Payer: BCN Commercial |
$926.00
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cofinity Commercial |
$1,122.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$955.50
|
| Rate for Payer: Healthscope Commercial |
$1,194.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,158.55
|
| Rate for Payer: Mclaren Commercial |
$1,074.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.22
|
| Rate for Payer: Nomi Health Commercial |
$979.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.05
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
OP
|
$4,903.14
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,593.47 |
| Max. Negotiated Rate |
$5,237.81 |
| Rate for Payer: Aetna Commercial |
$4,412.83
|
| Rate for Payer: Aetna Medicare |
$3,379.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: ASR ASR |
$4,756.05
|
| Rate for Payer: ASR Commercial |
$4,756.05
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,015.18
|
| Rate for Payer: BCN Commercial |
$3,801.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cofinity Commercial |
$4,608.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,922.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$4,903.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,756.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,379.23
|
| Rate for Payer: Mclaren Commercial |
$4,412.83
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,167.67
|
| Rate for Payer: Nomi Health Commercial |
$4,020.57
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,717.15
|
| Rate for Payer: PHP Medicaid |
$1,811.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,991.84
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,593.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,314.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,237.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP DNSP |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
IP
|
$4,903.14
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,187.04 |
| Max. Negotiated Rate |
$4,903.14 |
| Rate for Payer: Aetna Commercial |
$4,412.83
|
| Rate for Payer: ASR ASR |
$4,756.05
|
| Rate for Payer: ASR Commercial |
$4,756.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,995.57
|
| Rate for Payer: BCN Commercial |
$3,801.40
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cofinity Commercial |
$4,608.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,922.51
|
| Rate for Payer: Healthscope Commercial |
$4,903.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,756.05
|
| Rate for Payer: Mclaren Commercial |
$4,412.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,167.67
|
| Rate for Payer: Nomi Health Commercial |
$4,020.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,314.76
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
OP
|
$4,243.31
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.45 |
| Max. Negotiated Rate |
$4,243.31 |
| Rate for Payer: Aetna Commercial |
$3,818.98
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$4,116.01
|
| Rate for Payer: ASR Commercial |
$4,116.01
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,474.85
|
| Rate for Payer: BCN Commercial |
$3,289.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cofinity Commercial |
$3,988.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$4,243.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,116.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$3,818.98
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,606.81
|
| Rate for Payer: Nomi Health Commercial |
$3,479.51
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,758.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,734.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
IP
|
$4,243.31
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,758.15 |
| Max. Negotiated Rate |
$4,243.31 |
| Rate for Payer: Aetna Commercial |
$3,818.98
|
| Rate for Payer: ASR ASR |
$4,116.01
|
| Rate for Payer: ASR Commercial |
$4,116.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,457.87
|
| Rate for Payer: BCN Commercial |
$3,289.84
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cofinity Commercial |
$3,988.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.65
|
| Rate for Payer: Healthscope Commercial |
$4,243.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,116.01
|
| Rate for Payer: Mclaren Commercial |
$3,818.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,606.81
|
| Rate for Payer: Nomi Health Commercial |
$3,479.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,758.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,734.11
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$31.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.16
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: ASR Commercial |
$24.74
|
| Rate for Payer: BCBS Complete |
$17.63
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.33
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$16.79
|
| Rate for Payer: Mclaren Medicare |
$31.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Meridian Medicaid |
$17.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PACE Medicare |
$29.76
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PHP Commercial |
$34.46
|
| Rate for Payer: PHP Medicaid |
$16.79
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: Railroad Medicare Medicare |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.33
|
| Rate for Payer: UHC Exchange |
$48.56
|
| Rate for Payer: UHC Medicare Advantage |
$31.33
|
| Rate for Payer: UHCCP DNSP |
$31.33
|
| Rate for Payer: UHCCP Medicaid |
$16.79
|
| Rate for Payer: VA VA |
$31.33
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: ASR Commercial |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: ASR Commercial |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
|
