|
HC US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$397.99
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.83
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$294.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
IP
|
$431.77
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$280.65 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna Commercial |
$388.59
|
| Rate for Payer: ASR ASR |
$418.82
|
| Rate for Payer: ASR Commercial |
$418.82
|
| Rate for Payer: BCBS Trust/PPO |
$351.85
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$405.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Healthscope Whirlpool |
$418.82
|
| Rate for Payer: Mclaren Commercial |
$388.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.96
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
OP
|
$431.77
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$172.71 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna Commercial |
$388.59
|
| Rate for Payer: Aetna Medicare |
$215.88
|
| Rate for Payer: ASR ASR |
$418.82
|
| Rate for Payer: ASR Commercial |
$418.82
|
| Rate for Payer: BCBS Complete |
$172.71
|
| Rate for Payer: BCBS Trust/PPO |
$353.58
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$405.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Healthscope Whirlpool |
$418.82
|
| Rate for Payer: Mclaren Commercial |
$388.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.40
|
| Rate for Payer: Priority Health Narrow Network |
$285.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.96
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
IP
|
$355.44
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$355.44 |
| Rate for Payer: Aetna Commercial |
$319.90
|
| Rate for Payer: ASR ASR |
$344.78
|
| Rate for Payer: ASR Commercial |
$344.78
|
| Rate for Payer: BCBS Trust/PPO |
$289.65
|
| Rate for Payer: BCN Commercial |
$275.57
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.35
|
| Rate for Payer: Healthscope Commercial |
$355.44
|
| Rate for Payer: Healthscope Whirlpool |
$344.78
|
| Rate for Payer: Mclaren Commercial |
$319.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.12
|
| Rate for Payer: Nomi Health Commercial |
$291.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.79
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
OP
|
$355.44
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$357.40 |
| Rate for Payer: Aetna Commercial |
$319.90
|
| Rate for Payer: Aetna Medicare |
$177.72
|
| Rate for Payer: ASR ASR |
$344.78
|
| Rate for Payer: ASR Commercial |
$344.78
|
| Rate for Payer: BCBS Complete |
$142.18
|
| Rate for Payer: BCBS Trust/PPO |
$291.07
|
| Rate for Payer: BCN Commercial |
$275.57
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.35
|
| Rate for Payer: Healthscope Commercial |
$355.44
|
| Rate for Payer: Healthscope Whirlpool |
$344.78
|
| Rate for Payer: Mclaren Commercial |
$319.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.12
|
| Rate for Payer: Nomi Health Commercial |
$291.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.40
|
| Rate for Payer: Priority Health Narrow Network |
$285.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.79
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.25 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: ASR Commercial |
$201.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.56
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$208.08
|
| Rate for Payer: Healthscope Whirlpool |
$201.84
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: ASR Commercial |
$201.84
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$170.40
|
| Rate for Payer: BCCCP Commercial |
$86.41
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$208.08
|
| Rate for Payer: Healthscope Whirlpool |
$201.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$103.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: ASR Commercial |
$300.70
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$253.86
|
| Rate for Payer: BCCCP Commercial |
$86.41
|
| Rate for Payer: BCN Commercial |
$240.34
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$310.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$103.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: ASR Commercial |
$300.70
|
| Rate for Payer: BCBS Trust/PPO |
$252.62
|
| Rate for Payer: BCN Commercial |
$240.34
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$310.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.70
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: ASR Commercial |
$203.70
|
| Rate for Payer: BCBS Trust/PPO |
$171.13
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Healthscope Whirlpool |
$203.70
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: ASR Commercial |
$203.70
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$171.97
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Healthscope Whirlpool |
$203.70
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$237.46
|
| Rate for Payer: ASR Commercial |
$237.46
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$200.47
|
| Rate for Payer: BCN Commercial |
$189.79
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$230.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$244.80
|
| Rate for Payer: Healthscope Whirlpool |
$237.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$220.32
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$103.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: ASR ASR |
$237.46
|
| Rate for Payer: ASR Commercial |
$237.46
|
| Rate for Payer: BCBS Trust/PPO |
$199.49
|
| Rate for Payer: BCN Commercial |
$189.79
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$230.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$244.80
|
| Rate for Payer: Healthscope Whirlpool |
$237.46
|
| Rate for Payer: Mclaren Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.42
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$473.16
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$473.16 |
| Rate for Payer: Aetna Commercial |
$425.84
|
| Rate for Payer: Aetna Medicare |
$236.58
|
| Rate for Payer: ASR ASR |
$458.97
|
| Rate for Payer: ASR Commercial |
$458.97
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Trust/PPO |
$387.47
|
| Rate for Payer: BCN Commercial |
$366.84
|
| Rate for Payer: Cash Price |
$378.53
|
| Rate for Payer: Cofinity Commercial |
$444.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.53
|
| Rate for Payer: Healthscope Commercial |
$473.16
|
| Rate for Payer: Healthscope Whirlpool |
$458.97
|
| Rate for Payer: Mclaren Commercial |
$425.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.19
|
| Rate for Payer: Nomi Health Commercial |
$387.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.58
|
| Rate for Payer: Priority Health Narrow Network |
$331.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.38
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$473.16
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$307.55 |
| Max. Negotiated Rate |
$473.16 |
| Rate for Payer: Aetna Commercial |
$425.84
|
| Rate for Payer: ASR ASR |
$458.97
|
| Rate for Payer: ASR Commercial |
$458.97
|
| Rate for Payer: BCBS Trust/PPO |
$385.58
|
| Rate for Payer: BCN Commercial |
$366.84
|
| Rate for Payer: Cash Price |
$378.53
|
| Rate for Payer: Cofinity Commercial |
$444.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.53
|
| Rate for Payer: Healthscope Commercial |
$473.16
|
| Rate for Payer: Healthscope Whirlpool |
$458.97
|
| Rate for Payer: Mclaren Commercial |
$425.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.19
|
| Rate for Payer: Nomi Health Commercial |
$387.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.38
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$687.01
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$666.40
|
| Rate for Payer: ASR Commercial |
$666.40
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$562.59
|
| Rate for Payer: BCCCP Commercial |
$60.92
|
| Rate for Payer: BCN Commercial |
$532.64
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$645.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$687.01
|
| Rate for Payer: Healthscope Whirlpool |
$666.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$618.31
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.58
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$229.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$687.01
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.56 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: ASR ASR |
$666.40
|
| Rate for Payer: ASR Commercial |
$666.40
|
| Rate for Payer: BCBS Trust/PPO |
$559.84
|
| Rate for Payer: BCN Commercial |
$532.64
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$645.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Healthscope Commercial |
$687.01
|
| Rate for Payer: Healthscope Whirlpool |
$666.40
|
| Rate for Payer: Mclaren Commercial |
$618.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.57
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$687.01
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$666.40
|
| Rate for Payer: ASR Commercial |
$666.40
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$562.59
|
| Rate for Payer: BCN Commercial |
$532.64
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$645.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$687.01
|
| Rate for Payer: Healthscope Whirlpool |
$666.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$618.31
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.96
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$481.59
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$687.01
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.56 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: ASR ASR |
$666.40
|
| Rate for Payer: ASR Commercial |
$666.40
|
| Rate for Payer: BCBS Trust/PPO |
$559.84
|
| Rate for Payer: BCN Commercial |
$532.64
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$645.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Healthscope Commercial |
$687.01
|
| Rate for Payer: Healthscope Whirlpool |
$666.40
|
| Rate for Payer: Mclaren Commercial |
$618.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.57
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,212.48
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,212.48 |
| Rate for Payer: Aetna Commercial |
$1,091.23
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,176.11
|
| Rate for Payer: ASR Commercial |
$1,176.11
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$992.90
|
| Rate for Payer: BCN Commercial |
$940.04
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cofinity Commercial |
$1,139.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,212.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,091.23
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$994.23
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.76
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$239.81
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,212.48
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$788.11 |
| Max. Negotiated Rate |
$1,212.48 |
| Rate for Payer: Aetna Commercial |
$1,091.23
|
| Rate for Payer: ASR ASR |
$1,176.11
|
| Rate for Payer: ASR Commercial |
$1,176.11
|
| Rate for Payer: BCBS Trust/PPO |
$988.05
|
| Rate for Payer: BCN Commercial |
$940.04
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cofinity Commercial |
$1,139.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.98
|
| Rate for Payer: Healthscope Commercial |
$1,212.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.11
|
| Rate for Payer: Mclaren Commercial |
$1,091.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$994.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.98
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,425.09
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$2,425.09 |
| Rate for Payer: Aetna Commercial |
$2,182.58
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$2,352.34
|
| Rate for Payer: ASR Commercial |
$2,352.34
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,985.91
|
| Rate for Payer: BCN Commercial |
$1,880.17
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cofinity Commercial |
$2,279.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,940.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$2,425.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,352.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$2,182.58
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.33
|
| Rate for Payer: Nomi Health Commercial |
$1,988.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,576.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.76
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$239.81
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,134.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,425.09
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,576.31 |
| Max. Negotiated Rate |
$2,425.09 |
| Rate for Payer: Aetna Commercial |
$2,182.58
|
| Rate for Payer: ASR ASR |
$2,352.34
|
| Rate for Payer: ASR Commercial |
$2,352.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,976.21
|
| Rate for Payer: BCN Commercial |
$1,880.17
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cofinity Commercial |
$2,279.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,940.07
|
| Rate for Payer: Healthscope Commercial |
$2,425.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,352.34
|
| Rate for Payer: Mclaren Commercial |
$2,182.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.33
|
| Rate for Payer: Nomi Health Commercial |
$1,988.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,576.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,134.08
|
|
