|
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
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$90.05
|
| Rate for Payer: BCN Commercial |
$90.05
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCN Commercial |
$90.41
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.54
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$13.54
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicaid |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.98
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$52.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.99
|
| Rate for Payer: UHC Medicaid |
$7.08
|
| Rate for Payer: UHCCP DNSP |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.08
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$53.06
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$19.63
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$53.06
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.89
|
| Rate for Payer: BCN Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$16.17
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$36.03
|
| Rate for Payer: BCN Commercial |
$36.03
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.29
|
| Rate for Payer: Priority Health Narrow Network |
$30.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
OP
|
$141.18
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$141.18 |
| Rate for Payer: Aetna Commercial |
$127.06
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: ASR ASR |
$136.94
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$116.40
|
| Rate for Payer: BCN Commercial |
$116.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cofinity Commercial |
$132.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$136.94
|
| Rate for Payer: Healthscope Whirlpool |
$141.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.54
|
| Rate for Payer: Mclaren Commercial |
$127.06
|
| Rate for Payer: Mclaren Medicaid |
$13.54
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.00
|
| Rate for Payer: Nomi Health Commercial |
$115.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.89
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicaid |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.99
|
| Rate for Payer: UHC Medicaid |
$7.08
|
| Rate for Payer: UHCCP DNSP |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.08
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$141.18
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$141.18 |
| Rate for Payer: Aetna Commercial |
$127.06
|
| Rate for Payer: ASR ASR |
$136.94
|
| Rate for Payer: BCBS Trust/PPO |
$115.94
|
| Rate for Payer: BCN Commercial |
$115.94
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cofinity Commercial |
$132.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.94
|
| Rate for Payer: Healthscope Commercial |
$136.94
|
| Rate for Payer: Healthscope Whirlpool |
$141.18
|
| Rate for Payer: Mclaren Commercial |
$127.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.00
|
| Rate for Payer: Nomi Health Commercial |
$115.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.24
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$84.89 |
| Rate for Payer: Aetna Commercial |
$76.40
|
| Rate for Payer: Aetna Medicare |
$33.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.33
|
| Rate for Payer: ASR ASR |
$82.34
|
| Rate for Payer: BCBS Complete |
$18.60
|
| Rate for Payer: BCBS MAPPO |
$33.86
|
| Rate for Payer: BCBS Trust/PPO |
$69.99
|
| Rate for Payer: BCN Commercial |
$69.99
|
| Rate for Payer: BCN Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.86
|
| Rate for Payer: Healthscope Commercial |
$82.34
|
| Rate for Payer: Healthscope Whirlpool |
$84.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.86
|
| Rate for Payer: Mclaren Commercial |
$76.40
|
| Rate for Payer: Mclaren Medicaid |
$33.86
|
| Rate for Payer: Mclaren Medicare |
$33.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$18.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PACE Medicare |
$32.17
|
| Rate for Payer: PACE SWMI |
$33.86
|
| Rate for Payer: PHP Commercial |
$37.25
|
| Rate for Payer: PHP Medicaid |
$18.15
|
| Rate for Payer: PHP Medicare Advantage |
$33.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.38
|
| Rate for Payer: Priority Health Medicare |
$33.86
|
| Rate for Payer: Priority Health Narrow Network |
$59.51
|
| Rate for Payer: Railroad Medicare Medicare |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.86
|
| Rate for Payer: UHC Exchange |
$52.48
|
| Rate for Payer: UHC Medicaid |
$17.71
|
| Rate for Payer: UHCCP DNSP |
$33.86
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$33.86
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$84.89
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$84.89 |
| Rate for Payer: Aetna Commercial |
$76.40
|
| Rate for Payer: ASR ASR |
$82.34
|
| Rate for Payer: BCBS Trust/PPO |
$69.71
|
| Rate for Payer: BCN Commercial |
$69.71
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Healthscope Commercial |
$82.34
|
| Rate for Payer: Healthscope Whirlpool |
$84.89
|
| Rate for Payer: Mclaren Commercial |
$76.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.70
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.17
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.74
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$6.31
|
| Rate for Payer: PHP Medicaid |
$3.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow Network |
$28.08
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.74
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicaid |
$3.00
|
| Rate for Payer: UHCCP DNSP |
$5.74
|
| Rate for Payer: UHCCP Medicaid |
$3.00
|
| Rate for Payer: VA VA |
$5.74
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$224.97
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.73 |
| Max. Negotiated Rate |
$224.97 |
| Rate for Payer: Aetna Commercial |
$202.47
|
| Rate for Payer: ASR ASR |
$218.22
|
| Rate for Payer: BCBS Trust/PPO |
$184.75
|
| Rate for Payer: BCN Commercial |
$184.75
|
| Rate for Payer: Cash Price |
$179.98
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.98
|
| Rate for Payer: Healthscope Commercial |
$218.22
|
| Rate for Payer: Healthscope Whirlpool |
$224.97
|
| Rate for Payer: Mclaren Commercial |
$202.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.22
|
| Rate for Payer: Nomi Health Commercial |
$184.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.97
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$224.97
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.24 |
| Max. Negotiated Rate |
$224.97 |
| Rate for Payer: Aetna Commercial |
$202.47
|
| Rate for Payer: Aetna Medicare |
$83.24
|
| Rate for Payer: ASR ASR |
$218.22
|
| Rate for Payer: BCBS Complete |
$89.99
|
| Rate for Payer: BCBS Trust/PPO |
$185.49
|
| Rate for Payer: BCN Commercial |
$185.49
|
| Rate for Payer: Cash Price |
$179.98
|
| Rate for Payer: Cash Price |
$179.98
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.98
|
| Rate for Payer: Healthscope Commercial |
$218.22
|
| Rate for Payer: Healthscope Whirlpool |
$224.97
|
| Rate for Payer: Mclaren Commercial |
$202.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.22
|
| Rate for Payer: Nomi Health Commercial |
$184.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.87
|
| Rate for Payer: Priority Health Narrow Network |
$175.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.97
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$115.01 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$37.62
|
| Rate for Payer: BCN Commercial |
$37.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$92.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$45.63 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$37.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$82.19
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$115.01 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$67.77
|
| Rate for Payer: BCN Commercial |
$67.77
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$79.72
|
| Rate for Payer: Healthscope Whirlpool |
$82.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$92.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$82.19
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$82.19 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: BCBS Trust/PPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$67.49
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Healthscope Commercial |
$79.72
|
| Rate for Payer: Healthscope Whirlpool |
$82.19
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Trust/PPO |
$91.50
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$91.87
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.63
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$78.11
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Trust/PPO |
$51.59
|
| Rate for Payer: BCN Commercial |
$51.59
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCN Commercial |
$51.80
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$208.50
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Aetna Commercial |
$187.65
|
| Rate for Payer: ASR ASR |
$202.25
|
| Rate for Payer: BCBS Trust/PPO |
$171.22
|
| Rate for Payer: BCN Commercial |
$171.22
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cofinity Commercial |
$195.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.80
|
| Rate for Payer: Healthscope Commercial |
$202.25
|
| Rate for Payer: Healthscope Whirlpool |
$208.50
|
| Rate for Payer: Mclaren Commercial |
$187.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.22
|
| Rate for Payer: Nomi Health Commercial |
$170.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.48
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$208.50
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Aetna Commercial |
$187.65
|
| Rate for Payer: Aetna Medicare |
$77.14
|
| Rate for Payer: ASR ASR |
$202.25
|
| Rate for Payer: BCBS Complete |
$83.40
|
| Rate for Payer: BCBS Trust/PPO |
$171.91
|
| Rate for Payer: BCN Commercial |
$171.91
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cofinity Commercial |
$195.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.80
|
| Rate for Payer: Healthscope Commercial |
$202.25
|
| Rate for Payer: Healthscope Whirlpool |
$208.50
|
| Rate for Payer: Mclaren Commercial |
$187.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.22
|
| Rate for Payer: Nomi Health Commercial |
$170.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.69
|
| Rate for Payer: Priority Health Narrow Network |
$146.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.48
|
|
