|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$862.48
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$560.61 |
| Max. Negotiated Rate |
$862.48 |
| Rate for Payer: Aetna Commercial |
$776.23
|
| Rate for Payer: ASR ASR |
$836.61
|
| Rate for Payer: ASR Commercial |
$836.61
|
| Rate for Payer: BCBS Trust/PPO |
$702.83
|
| Rate for Payer: BCN Commercial |
$668.68
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$810.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$862.48
|
| Rate for Payer: Healthscope Whirlpool |
$836.61
|
| Rate for Payer: Mclaren Commercial |
$776.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.11
|
| Rate for Payer: Nomi Health Commercial |
$707.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$758.98
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$862.48
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$862.48 |
| Rate for Payer: Aetna Commercial |
$776.23
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: ASR ASR |
$836.61
|
| Rate for Payer: ASR Commercial |
$836.61
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$706.28
|
| Rate for Payer: BCN Commercial |
$668.68
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$810.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$862.48
|
| Rate for Payer: Healthscope Whirlpool |
$836.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$298.04
|
| Rate for Payer: Mclaren Commercial |
$776.23
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.11
|
| Rate for Payer: Nomi Health Commercial |
$707.23
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: PHP Medicaid |
$159.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.70
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$604.60
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$758.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$461.96
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| Rate for Payer: ASR ASR |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Trust/PPO |
$237.82
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| 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 |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$238.99
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| 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 |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| 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 |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.71
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$204.58
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
| 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 FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| Rate for Payer: ASR ASR |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Trust/PPO |
$237.82
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| 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 |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$238.99
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| 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 |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| 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 |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.83
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$115.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
| 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 GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$413.36
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.68 |
| Max. Negotiated Rate |
$413.36 |
| Rate for Payer: Aetna Commercial |
$372.02
|
| Rate for Payer: ASR ASR |
$400.96
|
| Rate for Payer: ASR Commercial |
$400.96
|
| Rate for Payer: BCBS Trust/PPO |
$336.85
|
| Rate for Payer: BCN Commercial |
$320.48
|
| Rate for Payer: Cash Price |
$330.69
|
| Rate for Payer: Cofinity Commercial |
$388.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.69
|
| Rate for Payer: Healthscope Commercial |
$413.36
|
| Rate for Payer: Healthscope Whirlpool |
$400.96
|
| Rate for Payer: Mclaren Commercial |
$372.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.36
|
| Rate for Payer: Nomi Health Commercial |
$338.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.76
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$413.36
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.34 |
| Max. Negotiated Rate |
$413.36 |
| Rate for Payer: Aetna Commercial |
$372.02
|
| Rate for Payer: Aetna Medicare |
$206.68
|
| Rate for Payer: ASR ASR |
$400.96
|
| Rate for Payer: ASR Commercial |
$400.96
|
| Rate for Payer: BCBS Complete |
$165.34
|
| Rate for Payer: BCBS Trust/PPO |
$338.50
|
| Rate for Payer: BCN Commercial |
$320.48
|
| Rate for Payer: Cash Price |
$330.69
|
| Rate for Payer: Cofinity Commercial |
$388.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.69
|
| Rate for Payer: Healthscope Commercial |
$413.36
|
| Rate for Payer: Healthscope Whirlpool |
$400.96
|
| Rate for Payer: Mclaren Commercial |
$372.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.36
|
| Rate for Payer: Nomi Health Commercial |
$338.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.19
|
| Rate for Payer: Priority Health Narrow Network |
$289.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.76
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$643.95
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.57 |
| Max. Negotiated Rate |
$643.95 |
| Rate for Payer: Aetna Commercial |
$579.56
|
| Rate for Payer: ASR ASR |
$624.63
|
| Rate for Payer: ASR Commercial |
$624.63
|
| Rate for Payer: BCBS Trust/PPO |
$524.75
|
| Rate for Payer: BCN Commercial |
$499.25
|
| Rate for Payer: Cash Price |
$515.16
|
| Rate for Payer: Cofinity Commercial |
$605.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.16
|
| Rate for Payer: Healthscope Commercial |
$643.95
|
| Rate for Payer: Healthscope Whirlpool |
$624.63
|
| Rate for Payer: Mclaren Commercial |
$579.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.36
|
| Rate for Payer: Nomi Health Commercial |
$528.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.68
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$643.95
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$643.95 |
| Rate for Payer: Aetna Commercial |
$579.56
|
| Rate for Payer: Aetna Medicare |
$321.98
|
| Rate for Payer: ASR ASR |
$624.63
|
| Rate for Payer: ASR Commercial |
$624.63
|
| Rate for Payer: BCBS Complete |
$257.58
|
| Rate for Payer: BCBS Trust/PPO |
$527.33
|
| Rate for Payer: BCCCP Commercial |
$55.83
|
| Rate for Payer: BCN Commercial |
$499.25
|
| Rate for Payer: Cash Price |
$515.16
|
| Rate for Payer: Cash Price |
$515.16
|
| Rate for Payer: Cofinity Commercial |
$605.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.16
|
| Rate for Payer: Healthscope Commercial |
$643.95
|
| Rate for Payer: Healthscope Whirlpool |
$624.63
|
| Rate for Payer: Mclaren Commercial |
$579.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.36
|
| Rate for Payer: Nomi Health Commercial |
$528.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.70
|
| Rate for Payer: Priority Health Narrow Network |
$333.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.68
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.23
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$367.09 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$292.66
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.91
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$281.53
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.54
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$291.63
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
IP
|
$324.21
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$210.74 |
| Max. Negotiated Rate |
$324.21 |
| Rate for Payer: Aetna Commercial |
$291.79
|
| Rate for Payer: ASR ASR |
$314.48
|
| Rate for Payer: ASR Commercial |
$314.48
|
| Rate for Payer: BCBS Trust/PPO |
$264.20
|
| Rate for Payer: BCN Commercial |
$251.36
|
| Rate for Payer: Cash Price |
$259.37
|
| Rate for Payer: Cofinity Commercial |
$304.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.37
|
| Rate for Payer: Healthscope Commercial |
$324.21
|
| Rate for Payer: Healthscope Whirlpool |
$314.48
|
| Rate for Payer: Mclaren Commercial |
$291.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.58
|
| Rate for Payer: Nomi Health Commercial |
$265.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.30
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
OP
|
$324.21
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$324.21 |
| Rate for Payer: Aetna Commercial |
$291.79
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$314.48
|
| Rate for Payer: ASR Commercial |
$314.48
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$265.50
|
| Rate for Payer: BCN Commercial |
$251.36
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$259.37
|
| Rate for Payer: Cash Price |
$259.37
|
| Rate for Payer: Cofinity Commercial |
$304.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$324.21
|
| Rate for Payer: Healthscope Whirlpool |
$314.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$291.79
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.58
|
| Rate for Payer: Nomi Health Commercial |
$265.85
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.07
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$227.27
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
IP
|
$592.16
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$384.90 |
| Max. Negotiated Rate |
$592.16 |
| Rate for Payer: Aetna Commercial |
$532.94
|
| Rate for Payer: ASR ASR |
$574.40
|
| Rate for Payer: ASR Commercial |
$574.40
|
| Rate for Payer: BCBS Trust/PPO |
$482.55
|
| Rate for Payer: BCN Commercial |
$459.10
|
| Rate for Payer: Cash Price |
$473.73
|
| Rate for Payer: Cofinity Commercial |
$556.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.73
|
| Rate for Payer: Healthscope Commercial |
$592.16
|
| Rate for Payer: Healthscope Whirlpool |
$574.40
|
| Rate for Payer: Mclaren Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.34
|
| Rate for Payer: Nomi Health Commercial |
$485.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.10
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
OP
|
$592.16
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.86 |
| Max. Negotiated Rate |
$592.16 |
| Rate for Payer: Aetna Commercial |
$532.94
|
| Rate for Payer: Aetna Medicare |
$296.08
|
| Rate for Payer: ASR ASR |
$574.40
|
| Rate for Payer: ASR Commercial |
$574.40
|
| Rate for Payer: BCBS Complete |
$236.86
|
| Rate for Payer: BCBS Trust/PPO |
$484.92
|
| Rate for Payer: BCN Commercial |
$459.10
|
| Rate for Payer: Cash Price |
$473.73
|
| Rate for Payer: Cash Price |
$473.73
|
| Rate for Payer: Cofinity Commercial |
$556.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.73
|
| Rate for Payer: Healthscope Commercial |
$592.16
|
| Rate for Payer: Healthscope Whirlpool |
$574.40
|
| Rate for Payer: Mclaren Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.34
|
| Rate for Payer: Nomi Health Commercial |
$485.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.70
|
| Rate for Payer: Priority Health Narrow Network |
$333.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.10
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: Aetna Medicare |
$291.64
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Complete |
$233.31
|
| Rate for Payer: BCBS Trust/PPO |
$477.65
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.07
|
| Rate for Payer: Priority Health Narrow Network |
$408.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.13 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Trust/PPO |
$475.31
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
|
|
HC US OB BPP WO NON STRESS
|
Facility
|
OP
|
$642.88
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$642.88 |
| Rate for Payer: Aetna Commercial |
$578.59
|
| 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 |
$623.59
|
| Rate for Payer: ASR Commercial |
$623.59
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$526.45
|
| Rate for Payer: BCN Commercial |
$498.42
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$604.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$642.88
|
| Rate for Payer: Healthscope Whirlpool |
$623.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$578.59
|
| 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 |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| 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 |
$417.87
|
| 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 |
$565.73
|
| 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 OB BPP WO NON STRESS
|
Facility
|
IP
|
$642.88
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$417.87 |
| Max. Negotiated Rate |
$642.88 |
| Rate for Payer: Aetna Commercial |
$578.59
|
| Rate for Payer: ASR ASR |
$623.59
|
| Rate for Payer: ASR Commercial |
$623.59
|
| Rate for Payer: BCBS Trust/PPO |
$523.88
|
| Rate for Payer: BCN Commercial |
$498.42
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$604.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$642.88
|
| Rate for Payer: Healthscope Whirlpool |
$623.59
|
| Rate for Payer: Mclaren Commercial |
$578.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.73
|
|
|
HC US OB DETAILED
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.13 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Trust/PPO |
$475.31
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
|
|
HC US OB DETAILED
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$617.63 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$477.65
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.63
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$494.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
