|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.45 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Aetna Commercial |
$468.54
|
| Rate for Payer: ASR ASR |
$504.98
|
| Rate for Payer: BCBS Trust/PPO |
$427.52
|
| Rate for Payer: BCN Commercial |
$427.52
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$489.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$504.98
|
| Rate for Payer: Healthscope Whirlpool |
$520.60
|
| Rate for Payer: Mclaren Commercial |
$468.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.13
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Aetna Commercial |
$468.54
|
| 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 |
$504.98
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$429.23
|
| Rate for Payer: BCN Commercial |
$429.23
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$489.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$504.98
|
| Rate for Payer: Healthscope Whirlpool |
$520.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$468.54
|
| 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 |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| 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 |
$456.15
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$364.94
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.13
|
| 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 UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,164.37 |
| Max. Negotiated Rate |
$8,219.16 |
| Rate for Payer: Aetna Commercial |
$7,397.24
|
| Rate for Payer: ASR ASR |
$7,972.59
|
| Rate for Payer: BCBS Trust/PPO |
$6,749.57
|
| Rate for Payer: BCN Commercial |
$6,749.57
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Commercial |
$7,726.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Healthscope Commercial |
$7,972.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,219.16
|
| Rate for Payer: Mclaren Commercial |
$7,397.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$6,739.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,232.86
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$8,219.16 |
| Rate for Payer: Aetna Commercial |
$7,397.24
|
| Rate for Payer: Aetna Medicare |
$3,303.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: ASR ASR |
$7,972.59
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$6,776.70
|
| Rate for Payer: BCN Commercial |
$6,776.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Commercial |
$7,726.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,972.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,219.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,303.54
|
| Rate for Payer: Mclaren Commercial |
$7,397.24
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$1,814.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$6,739.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$3,633.89
|
| Rate for Payer: PHP Medicaid |
$1,770.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,201.63
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Narrow Network |
$5,761.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,232.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$5,120.49
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP DNSP |
$3,303.54
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$370.64 |
| Max. Negotiated Rate |
$494.19 |
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: ASR ASR |
$479.36
|
| Rate for Payer: BCBS Trust/PPO |
$405.83
|
| Rate for Payer: BCN Commercial |
$405.83
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$464.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$479.36
|
| Rate for Payer: Healthscope Whirlpool |
$494.19
|
| Rate for Payer: Mclaren Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.89
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$182.85 |
| Max. Negotiated Rate |
$494.19 |
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: Aetna Medicare |
$182.85
|
| Rate for Payer: ASR ASR |
$479.36
|
| Rate for Payer: BCBS Complete |
$197.68
|
| Rate for Payer: BCBS Trust/PPO |
$407.46
|
| Rate for Payer: BCN Commercial |
$407.46
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$464.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$479.36
|
| Rate for Payer: Healthscope Whirlpool |
$494.19
|
| Rate for Payer: Mclaren Commercial |
$444.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$433.01
|
| Rate for Payer: Priority Health Narrow Network |
$346.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.89
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$105.86
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$235.90
|
| Rate for Payer: BCN Commercial |
$235.90
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$234.95
|
| Rate for Payer: BCN Commercial |
$234.95
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.81
|
| Rate for Payer: BCN Commercial |
$59.81
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$60.05
|
| Rate for Payer: BCN Commercial |
$60.05
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$185.47
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Aetna Commercial |
$166.92
|
| Rate for Payer: ASR ASR |
$179.91
|
| Rate for Payer: BCBS Trust/PPO |
$152.31
|
| Rate for Payer: BCN Commercial |
$152.31
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cofinity Commercial |
$174.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.38
|
| Rate for Payer: Healthscope Commercial |
$179.91
|
| Rate for Payer: Healthscope Whirlpool |
$185.47
|
| Rate for Payer: Mclaren Commercial |
$166.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.65
|
| Rate for Payer: Nomi Health Commercial |
$152.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.21
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$185.47
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Aetna Commercial |
$166.92
|
| Rate for Payer: Aetna Medicare |
$68.62
|
| Rate for Payer: ASR ASR |
$179.91
|
| Rate for Payer: BCBS Complete |
$74.19
|
| Rate for Payer: BCBS Trust/PPO |
$152.92
|
| Rate for Payer: BCN Commercial |
$152.92
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cofinity Commercial |
$174.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.38
|
| Rate for Payer: Healthscope Commercial |
$179.91
|
| Rate for Payer: Healthscope Whirlpool |
$185.47
|
| Rate for Payer: Mclaren Commercial |
$166.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.65
|
| Rate for Payer: Nomi Health Commercial |
$152.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.36
|
| Rate for Payer: Priority Health Narrow Network |
$61.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.21
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$69.38
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.03 |
| Max. Negotiated Rate |
$69.38 |
| Rate for Payer: Aetna Commercial |
$62.44
|
| Rate for Payer: ASR ASR |
$67.30
|
| Rate for Payer: BCBS Trust/PPO |
$56.97
|
| Rate for Payer: BCN Commercial |
$56.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cofinity Commercial |
$65.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$67.30
|
| Rate for Payer: Healthscope Whirlpool |
$69.38
|
| Rate for Payer: Mclaren Commercial |
$62.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.97
|
| Rate for Payer: Nomi Health Commercial |
$56.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.05
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$69.38
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$69.38 |
| Rate for Payer: Aetna Commercial |
$62.44
|
| Rate for Payer: Aetna Medicare |
$25.67
|
| Rate for Payer: ASR ASR |
$67.30
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$57.20
|
| Rate for Payer: BCN Commercial |
$57.20
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cofinity Commercial |
$65.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$67.30
|
| Rate for Payer: Healthscope Whirlpool |
$69.38
|
| Rate for Payer: Mclaren Commercial |
$62.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.97
|
| Rate for Payer: Nomi Health Commercial |
$56.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.38
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.05
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: ASR ASR |
$72.06
|
| Rate for Payer: BCBS Trust/PPO |
$61.01
|
| Rate for Payer: BCN Commercial |
$61.01
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$72.06
|
| Rate for Payer: Healthscope Whirlpool |
$74.29
|
| Rate for Payer: Mclaren Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.38
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna Medicare |
$27.49
|
| Rate for Payer: ASR ASR |
$72.06
|
| Rate for Payer: BCBS Complete |
$29.72
|
| Rate for Payer: BCBS Trust/PPO |
$61.25
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$72.06
|
| Rate for Payer: Healthscope Whirlpool |
$74.29
|
| Rate for Payer: Mclaren Commercial |
$66.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.38
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$856.30
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$290.99 |
| Max. Negotiated Rate |
$856.30 |
| Rate for Payer: Aetna Commercial |
$770.67
|
| Rate for Payer: Aetna Medicare |
$316.83
|
| Rate for Payer: ASR ASR |
$830.61
|
| Rate for Payer: BCBS Complete |
$342.52
|
| Rate for Payer: BCBS Trust/PPO |
$706.02
|
| Rate for Payer: BCN Commercial |
$706.02
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cofinity Commercial |
$804.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$830.61
|
| Rate for Payer: Healthscope Whirlpool |
$856.30
|
| Rate for Payer: Mclaren Commercial |
$770.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.86
|
| Rate for Payer: Nomi Health Commercial |
$702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$363.74
|
| Rate for Payer: Priority Health Narrow Network |
$290.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$753.54
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$856.30
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$642.23 |
| Max. Negotiated Rate |
$856.30 |
| Rate for Payer: Aetna Commercial |
$770.67
|
| Rate for Payer: ASR ASR |
$830.61
|
| Rate for Payer: BCBS Trust/PPO |
$703.19
|
| Rate for Payer: BCN Commercial |
$703.19
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cofinity Commercial |
$804.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$830.61
|
| Rate for Payer: Healthscope Whirlpool |
$856.30
|
| Rate for Payer: Mclaren Commercial |
$770.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.86
|
| Rate for Payer: Nomi Health Commercial |
$702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$753.54
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$812.76
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.57 |
| Max. Negotiated Rate |
$812.76 |
| Rate for Payer: Aetna Commercial |
$731.48
|
| Rate for Payer: ASR ASR |
$788.38
|
| Rate for Payer: BCBS Trust/PPO |
$667.44
|
| Rate for Payer: BCN Commercial |
$667.44
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cofinity Commercial |
$763.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.21
|
| Rate for Payer: Healthscope Commercial |
$788.38
|
| Rate for Payer: Healthscope Whirlpool |
$812.76
|
| Rate for Payer: Mclaren Commercial |
$731.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.85
|
| Rate for Payer: Nomi Health Commercial |
$666.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.23
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$812.76
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.39 |
| Max. Negotiated Rate |
$812.76 |
| Rate for Payer: Aetna Commercial |
$731.48
|
| Rate for Payer: Aetna Medicare |
$300.72
|
| Rate for Payer: ASR ASR |
$788.38
|
| Rate for Payer: BCBS Complete |
$325.10
|
| Rate for Payer: BCBS Trust/PPO |
$670.12
|
| Rate for Payer: BCN Commercial |
$670.12
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cofinity Commercial |
$763.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.21
|
| Rate for Payer: Healthscope Commercial |
$788.38
|
| Rate for Payer: Healthscope Whirlpool |
$812.76
|
| Rate for Payer: Mclaren Commercial |
$731.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.85
|
| Rate for Payer: Nomi Health Commercial |
$666.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$349.24
|
| Rate for Payer: Priority Health Narrow Network |
$279.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.23
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
OP
|
$1,511.95
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$559.42 |
| Max. Negotiated Rate |
$1,511.95 |
| Rate for Payer: Aetna Commercial |
$1,360.76
|
| Rate for Payer: Aetna Medicare |
$559.42
|
| Rate for Payer: ASR ASR |
$1,466.59
|
| Rate for Payer: BCBS Complete |
$604.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.60
|
| Rate for Payer: BCN Commercial |
$1,246.60
|
| Rate for Payer: Cash Price |
$1,209.56
|
| Rate for Payer: Cofinity Commercial |
$1,421.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.56
|
| Rate for Payer: Healthscope Commercial |
$1,466.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,511.95
|
| Rate for Payer: Mclaren Commercial |
$1,360.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,209.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,285.16
|
| Rate for Payer: Nomi Health Commercial |
$1,239.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,324.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,059.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.52
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
IP
|
$1,511.95
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,133.96 |
| Max. Negotiated Rate |
$1,511.95 |
| Rate for Payer: Aetna Commercial |
$1,360.76
|
| Rate for Payer: ASR ASR |
$1,466.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.61
|
| Rate for Payer: BCN Commercial |
$1,241.61
|
| Rate for Payer: Cash Price |
$1,209.56
|
| Rate for Payer: Cofinity Commercial |
$1,421.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.56
|
| Rate for Payer: Healthscope Commercial |
$1,466.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,511.95
|
| Rate for Payer: Mclaren Commercial |
$1,360.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,285.16
|
| Rate for Payer: Nomi Health Commercial |
$1,239.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.52
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,828.26
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$676.46 |
| Max. Negotiated Rate |
$1,828.26 |
| Rate for Payer: Aetna Commercial |
$1,645.43
|
| Rate for Payer: Aetna Medicare |
$676.46
|
| Rate for Payer: ASR ASR |
$1,773.41
|
| Rate for Payer: BCBS Complete |
$731.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.40
|
| Rate for Payer: BCN Commercial |
$1,507.40
|
| Rate for Payer: Cash Price |
$1,462.61
|
| Rate for Payer: Cofinity Commercial |
$1,718.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.61
|
| Rate for Payer: Healthscope Commercial |
$1,773.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,828.26
|
| Rate for Payer: Mclaren Commercial |
$1,645.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.02
|
| Rate for Payer: Nomi Health Commercial |
$1,499.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,601.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,281.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,608.87
|
|
