|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
OP
|
$34,088.40
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$34,088.40 |
| Rate for Payer: Aetna Commercial |
$30,679.56
|
| Rate for Payer: Aetna Medicare |
$18,265.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: ASR ASR |
$33,065.75
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$28,105.89
|
| Rate for Payer: BCN Commercial |
$28,105.89
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$27,270.72
|
| Rate for Payer: Cash Price |
$27,270.72
|
| Rate for Payer: Cofinity Commercial |
$32,043.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$33,065.75
|
| Rate for Payer: Healthscope Whirlpool |
$34,088.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,265.72
|
| Rate for Payer: Mclaren Commercial |
$30,679.56
|
| Rate for Payer: Mclaren Medicaid |
$18,265.72
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$10,031.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,975.14
|
| Rate for Payer: Nomi Health Commercial |
$27,952.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,566.30
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$20,092.29
|
| Rate for Payer: PHP Medicaid |
$9,790.43
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,868.26
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health Narrow Network |
$23,895.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29,997.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Exchange |
$28,311.87
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP DNSP |
$18,265.72
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
IP
|
$34,088.40
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,566.30 |
| Max. Negotiated Rate |
$34,088.40 |
| Rate for Payer: Aetna Commercial |
$30,679.56
|
| Rate for Payer: ASR ASR |
$33,065.75
|
| Rate for Payer: BCBS Trust/PPO |
$27,993.39
|
| Rate for Payer: BCN Commercial |
$27,993.39
|
| Rate for Payer: Cash Price |
$27,270.72
|
| Rate for Payer: Cofinity Commercial |
$32,043.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,270.72
|
| Rate for Payer: Healthscope Commercial |
$33,065.75
|
| Rate for Payer: Healthscope Whirlpool |
$34,088.40
|
| Rate for Payer: Mclaren Commercial |
$30,679.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,975.14
|
| Rate for Payer: Nomi Health Commercial |
$27,952.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,566.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29,997.79
|
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,360.69
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.52 |
| Max. Negotiated Rate |
$2,360.69 |
| Rate for Payer: Aetna Commercial |
$2,124.62
|
| Rate for Payer: ASR ASR |
$2,289.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.60
|
| Rate for Payer: BCN Commercial |
$1,938.60
|
| Rate for Payer: Cash Price |
$1,888.55
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.55
|
| Rate for Payer: Healthscope Commercial |
$2,289.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,360.69
|
| Rate for Payer: Mclaren Commercial |
$2,124.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.59
|
| Rate for Payer: Nomi Health Commercial |
$1,935.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,770.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,077.41
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,360.69
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.46 |
| Max. Negotiated Rate |
$2,360.69 |
| Rate for Payer: Aetna Commercial |
$2,124.62
|
| Rate for Payer: Aetna Medicare |
$873.46
|
| Rate for Payer: ASR ASR |
$2,289.87
|
| Rate for Payer: BCBS Complete |
$944.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,946.39
|
| Rate for Payer: BCN Commercial |
$1,946.39
|
| Rate for Payer: Cash Price |
$1,888.55
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.55
|
| Rate for Payer: Healthscope Commercial |
$2,289.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,360.69
|
| Rate for Payer: Mclaren Commercial |
$2,124.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,888.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.59
|
| Rate for Payer: Nomi Health Commercial |
$1,935.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,770.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,068.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,654.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,077.41
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$70.59
|
| Rate for Payer: BCN Commercial |
$70.59
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$83.38
|
| Rate for Payer: Healthscope Whirlpool |
$85.96
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Nomi Health Commercial |
$70.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$35.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$70.87
|
| Rate for Payer: BCN Commercial |
$70.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$83.38
|
| Rate for Payer: Healthscope Whirlpool |
$85.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Mclaren Medicaid |
$35.33
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$19.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Nomi Health Commercial |
$70.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.47
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$38.86
|
| Rate for Payer: PHP Medicaid |
$18.94
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.32
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health Narrow Network |
$60.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.33
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicaid |
$18.48
|
| Rate for Payer: UHCCP DNSP |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$18.48
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$76.41
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: Aetna Medicare |
$28.27
|
| Rate for Payer: ASR ASR |
$74.12
|
| Rate for Payer: BCBS Complete |
$30.56
|
| Rate for Payer: BCBS Trust/PPO |
$63.00
|
| Rate for Payer: BCN Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$76.41
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: ASR ASR |
$74.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.75
|
| Rate for Payer: BCN Commercial |
$62.75
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$44.78 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$35.00
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$29.75
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$32.47
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$29.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$36.08 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: ASR ASR |
$35.00
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.08
|
| Rate for Payer: Mclaren Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$29.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.75
|
|
|
HC VDRL TITER CSF
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$63.48
|
| Rate for Payer: BCN Commercial |
$63.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$74.68
|
| Rate for Payer: Healthscope Whirlpool |
$76.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicaid |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.46
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicaid |
$2.30
|
| Rate for Payer: UHCCP DNSP |
$4.40
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC VDRL TITER CSF
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: BCBS Trust/PPO |
$63.22
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$74.68
|
| Rate for Payer: Healthscope Whirlpool |
$76.99
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
|
|
HC VEDOLIZUMAB
|
Facility
|
OP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$345.01 |
| Rate for Payer: Aetna Commercial |
$152.63
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$164.50
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$139.83
|
| Rate for Payer: BCN Commercial |
$139.83
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$169.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$152.63
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$276.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC VEDOLIZUMAB
|
Facility
|
IP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.19 |
| Max. Negotiated Rate |
$169.59 |
| Rate for Payer: Aetna Commercial |
$152.63
|
| Rate for Payer: ASR ASR |
$164.50
|
| Rate for Payer: BCBS Trust/PPO |
$139.27
|
| Rate for Payer: BCN Commercial |
$139.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$169.59
|
| Rate for Payer: Mclaren Commercial |
$152.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.24
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
OP
|
$134.21
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$134.21 |
| Rate for Payer: Aetna Commercial |
$120.79
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$130.18
|
| Rate for Payer: BCBS Complete |
$7.75
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$110.66
|
| Rate for Payer: BCN Commercial |
$110.66
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$130.18
|
| Rate for Payer: Healthscope Whirlpool |
$134.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$120.79
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Nomi Health Commercial |
$110.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$117.59
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$94.08
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicaid |
$7.38
|
| Rate for Payer: UHCCP DNSP |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.66 |
| Max. Negotiated Rate |
$134.21 |
| Rate for Payer: Aetna Commercial |
$120.79
|
| Rate for Payer: ASR ASR |
$130.18
|
| Rate for Payer: BCBS Trust/PPO |
$110.21
|
| Rate for Payer: BCN Commercial |
$110.21
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Healthscope Commercial |
$130.18
|
| Rate for Payer: Healthscope Whirlpool |
$134.21
|
| Rate for Payer: Mclaren Commercial |
$120.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Nomi Health Commercial |
$110.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.10
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
IP
|
$133.17
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$133.17 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: ASR ASR |
$129.17
|
| Rate for Payer: BCBS Trust/PPO |
$109.36
|
| Rate for Payer: BCN Commercial |
$109.36
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Commercial |
$125.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Healthscope Commercial |
$129.17
|
| Rate for Payer: Healthscope Whirlpool |
$133.17
|
| Rate for Payer: Mclaren Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.19
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
OP
|
$133.17
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$129.17
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$109.80
|
| Rate for Payer: BCN Commercial |
$109.80
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Commercial |
$125.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$129.17
|
| Rate for Payer: Healthscope Whirlpool |
$133.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$119.85
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.88
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$253.86 |
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: ASR ASR |
$246.24
|
| Rate for Payer: BCBS Trust/PPO |
$208.47
|
| Rate for Payer: BCN Commercial |
$208.47
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$238.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Whirlpool |
$253.86
|
| Rate for Payer: Mclaren Commercial |
$228.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.40
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$253.86 |
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$246.24
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$209.31
|
| Rate for Payer: BCN Commercial |
$209.31
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$238.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Whirlpool |
$253.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$228.47
|
| Rate for Payer: Mclaren Medicaid |
$38.57
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.69
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$38.95
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
OP
|
$1,041.69
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,041.69 |
| Rate for Payer: Aetna Commercial |
$937.52
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,010.44
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$858.87
|
| Rate for Payer: BCN Commercial |
$858.87
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Commercial |
$979.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$937.52
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.44
|
| Rate for Payer: Nomi Health Commercial |
$854.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$612.90
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$490.32
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
IP
|
$1,041.69
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$781.27 |
| Max. Negotiated Rate |
$1,041.69 |
| Rate for Payer: Aetna Commercial |
$937.52
|
| Rate for Payer: ASR ASR |
$1,010.44
|
| Rate for Payer: BCBS Trust/PPO |
$855.44
|
| Rate for Payer: BCN Commercial |
$855.44
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Commercial |
$979.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Healthscope Commercial |
$1,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.69
|
| Rate for Payer: Mclaren Commercial |
$937.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.44
|
| Rate for Payer: Nomi Health Commercial |
$854.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.69
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
IP
|
$2,490.80
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,868.10 |
| Max. Negotiated Rate |
$2,490.80 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: ASR ASR |
$2,416.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.44
|
| Rate for Payer: BCN Commercial |
$2,045.44
|
| Rate for Payer: Cash Price |
$1,992.64
|
| Rate for Payer: Cofinity Commercial |
$2,341.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,992.64
|
| Rate for Payer: Healthscope Commercial |
$2,416.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,490.80
|
| Rate for Payer: Mclaren Commercial |
$2,241.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,117.18
|
| Rate for Payer: Nomi Health Commercial |
$2,042.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,868.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,191.90
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
OP
|
$2,490.80
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,490.80 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$2,416.08
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,053.66
|
| Rate for Payer: BCN Commercial |
$2,053.66
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,992.64
|
| Rate for Payer: Cash Price |
$1,992.64
|
| Rate for Payer: Cofinity Commercial |
$2,341.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,992.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,416.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,490.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$2,241.72
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,117.18
|
| Rate for Payer: Nomi Health Commercial |
$2,042.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,868.10
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$612.90
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$490.32
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,191.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
OP
|
$1,094.36
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,094.36 |
| Rate for Payer: Aetna Commercial |
$984.92
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,061.53
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$902.30
|
| Rate for Payer: BCN Commercial |
$902.30
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$875.49
|
| Rate for Payer: Cash Price |
$875.49
|
| Rate for Payer: Cofinity Commercial |
$1,028.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,061.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,094.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$984.92
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.21
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.77
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$319.43
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$255.54
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$963.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
