|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| 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 |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$417.96
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| 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 |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| 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 |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.20
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$357.78
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
| 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 UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.14 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| Rate for Payer: Aetna Medicare |
$3,177.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: ASR ASR |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,598.70
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,177.50
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$3,495.25
|
| Rate for Payer: PHP Medicaid |
$1,703.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,060.42
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$5,648.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$4,925.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP DNSP |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,237.70 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| Rate for Payer: ASR ASR |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Trust/PPO |
$6,566.46
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Medicare |
$242.25
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: ASR Commercial |
$469.96
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$396.76
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.52
|
| Rate for Payer: Priority Health Narrow Network |
$339.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$314.92 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: ASR Commercial |
$469.96
|
| Rate for Payer: BCBS Trust/PPO |
$394.82
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$181.83 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: Aetna Medicare |
$90.92
|
| Rate for Payer: ASR ASR |
$176.38
|
| Rate for Payer: ASR Commercial |
$176.38
|
| Rate for Payer: BCBS Complete |
$72.73
|
| Rate for Payer: BCBS Trust/PPO |
$148.90
|
| Rate for Payer: BCN Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$170.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$181.83
|
| Rate for Payer: Healthscope Whirlpool |
$176.38
|
| Rate for Payer: Mclaren Commercial |
$163.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.36
|
| Rate for Payer: Priority Health Narrow Network |
$61.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.01
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.19 |
| Max. Negotiated Rate |
$181.83 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: ASR ASR |
$176.38
|
| Rate for Payer: ASR Commercial |
$176.38
|
| Rate for Payer: BCBS Trust/PPO |
$148.17
|
| Rate for Payer: BCN Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$170.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$181.83
|
| Rate for Payer: Healthscope Whirlpool |
$176.38
|
| Rate for Payer: Mclaren Commercial |
$163.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.01
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$68.02 |
| Rate for Payer: Aetna Commercial |
$61.22
|
| Rate for Payer: Aetna Medicare |
$34.01
|
| Rate for Payer: ASR ASR |
$65.98
|
| Rate for Payer: ASR Commercial |
$65.98
|
| Rate for Payer: BCBS Complete |
$27.21
|
| Rate for Payer: BCBS Trust/PPO |
$55.70
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$68.02
|
| Rate for Payer: Healthscope Whirlpool |
$65.98
|
| Rate for Payer: Mclaren Commercial |
$61.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: Nomi Health Commercial |
$55.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.38
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.86
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$68.02 |
| Rate for Payer: Aetna Commercial |
$61.22
|
| Rate for Payer: ASR ASR |
$65.98
|
| Rate for Payer: ASR Commercial |
$65.98
|
| Rate for Payer: BCBS Trust/PPO |
$55.43
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$68.02
|
| Rate for Payer: Healthscope Whirlpool |
$65.98
|
| Rate for Payer: Mclaren Commercial |
$61.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: Nomi Health Commercial |
$55.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.86
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$545.68 |
| Max. Negotiated Rate |
$839.51 |
| Rate for Payer: Aetna Commercial |
$755.56
|
| Rate for Payer: ASR ASR |
$814.32
|
| Rate for Payer: ASR Commercial |
$814.32
|
| Rate for Payer: BCBS Trust/PPO |
$684.12
|
| Rate for Payer: BCN Commercial |
$650.87
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$789.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Healthscope Commercial |
$839.51
|
| Rate for Payer: Healthscope Whirlpool |
$814.32
|
| Rate for Payer: Mclaren Commercial |
$755.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: Nomi Health Commercial |
$688.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.77
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$839.51 |
| Rate for Payer: Aetna Commercial |
$755.56
|
| Rate for Payer: Aetna Medicare |
$419.76
|
| Rate for Payer: ASR ASR |
$814.32
|
| Rate for Payer: ASR Commercial |
$814.32
|
| Rate for Payer: BCBS Complete |
$335.80
|
| Rate for Payer: BCBS Trust/PPO |
$687.47
|
| Rate for Payer: BCN Commercial |
$650.87
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$789.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Healthscope Commercial |
$839.51
|
| Rate for Payer: Healthscope Whirlpool |
$814.32
|
| Rate for Payer: Mclaren Commercial |
$755.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: Nomi Health Commercial |
$688.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.75
|
| Rate for Payer: Priority Health Narrow Network |
$279.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.77
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.93 |
| Max. Negotiated Rate |
$796.82 |
| Rate for Payer: Aetna Commercial |
$717.14
|
| Rate for Payer: ASR ASR |
$772.92
|
| Rate for Payer: ASR Commercial |
$772.92
|
| Rate for Payer: BCBS Trust/PPO |
$649.33
|
| Rate for Payer: BCN Commercial |
$617.77
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$749.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Healthscope Commercial |
$796.82
|
| Rate for Payer: Healthscope Whirlpool |
$772.92
|
| Rate for Payer: Mclaren Commercial |
$717.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: Nomi Health Commercial |
$653.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$701.20
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.13 |
| Max. Negotiated Rate |
$796.82 |
| Rate for Payer: Aetna Commercial |
$717.14
|
| Rate for Payer: Aetna Medicare |
$398.41
|
| Rate for Payer: ASR ASR |
$772.92
|
| Rate for Payer: ASR Commercial |
$772.92
|
| Rate for Payer: BCBS Complete |
$318.73
|
| Rate for Payer: BCBS Trust/PPO |
$652.52
|
| Rate for Payer: BCN Commercial |
$617.77
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$749.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Healthscope Commercial |
$796.82
|
| Rate for Payer: Healthscope Whirlpool |
$772.92
|
| Rate for Payer: Mclaren Commercial |
$717.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: Nomi Health Commercial |
$653.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.16
|
| Rate for Payer: Priority Health Narrow Network |
$268.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$701.20
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
OP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$592.92 |
| Max. Negotiated Rate |
$1,482.30 |
| Rate for Payer: Aetna Commercial |
$1,334.07
|
| Rate for Payer: Aetna Medicare |
$741.15
|
| Rate for Payer: ASR ASR |
$1,437.83
|
| Rate for Payer: ASR Commercial |
$1,437.83
|
| Rate for Payer: BCBS Complete |
$592.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.86
|
| Rate for Payer: BCN Commercial |
$1,149.23
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,393.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Healthscope Commercial |
$1,482.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.83
|
| Rate for Payer: Mclaren Commercial |
$1,334.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.96
|
| Rate for Payer: Nomi Health Commercial |
$1,215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,298.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,039.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.42
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
IP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$963.50 |
| Max. Negotiated Rate |
$1,482.30 |
| Rate for Payer: Aetna Commercial |
$1,334.07
|
| Rate for Payer: ASR ASR |
$1,437.83
|
| Rate for Payer: ASR Commercial |
$1,437.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.93
|
| Rate for Payer: BCN Commercial |
$1,149.23
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,393.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Healthscope Commercial |
$1,482.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.83
|
| Rate for Payer: Mclaren Commercial |
$1,334.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.96
|
| Rate for Payer: Nomi Health Commercial |
$1,215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.42
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
IP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,165.07 |
| Max. Negotiated Rate |
$1,792.41 |
| Rate for Payer: Aetna Commercial |
$1,613.17
|
| Rate for Payer: ASR ASR |
$1,738.64
|
| Rate for Payer: ASR Commercial |
$1,738.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,460.63
|
| Rate for Payer: BCN Commercial |
$1,389.66
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,684.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Healthscope Commercial |
$1,792.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,738.64
|
| Rate for Payer: Mclaren Commercial |
$1,613.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: Nomi Health Commercial |
$1,469.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.32
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$716.96 |
| Max. Negotiated Rate |
$1,792.41 |
| Rate for Payer: Aetna Commercial |
$1,613.17
|
| Rate for Payer: Aetna Medicare |
$896.20
|
| Rate for Payer: ASR ASR |
$1,738.64
|
| Rate for Payer: ASR Commercial |
$1,738.64
|
| Rate for Payer: BCBS Complete |
$716.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.80
|
| Rate for Payer: BCN Commercial |
$1,389.66
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,684.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Healthscope Commercial |
$1,792.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,738.64
|
| Rate for Payer: Mclaren Commercial |
$1,613.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: Nomi Health Commercial |
$1,469.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,570.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.32
|
|
