|
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 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 |
$72.73 |
| 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: 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 |
$159.32
|
| Rate for Payer: Priority Health Narrow Network |
$127.46
|
| 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 |
$27.21 |
| 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: 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 |
$59.60
|
| Rate for Payer: Priority Health Narrow Network |
$47.68
|
| 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
|
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 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 |
$29.13 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| 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: 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 |
$63.81
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| 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 |
$335.80 |
| Max. Negotiated Rate |
$839.51 |
| Rate for Payer: Aetna Commercial |
$755.56
|
| Rate for Payer: Aetna Medicare |
$419.75
|
| 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: 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 |
$735.58
|
| Rate for Payer: Priority Health Narrow Network |
$588.50
|
| 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 |
$318.73 |
| 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: 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 |
$698.17
|
| Rate for Payer: Priority Health Narrow Network |
$558.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$701.20
|
|
|
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 |
$1,259.95
|
| 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 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 |
$1,259.95
|
| 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 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 |
$896.21
|
| 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
|
|
|
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 VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$88.04
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.54
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicaid |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.20
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.36
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.99
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHCCP DNSP |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
OP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$138.41 |
| Rate for Payer: Aetna Commercial |
$124.57
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: ASR ASR |
$134.26
|
| Rate for Payer: ASR Commercial |
$134.26
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$113.34
|
| Rate for Payer: BCN Commercial |
$107.31
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$138.41
|
| Rate for Payer: Healthscope Whirlpool |
$134.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.54
|
| Rate for Payer: Mclaren Commercial |
$124.57
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$113.50
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicaid |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.27
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$97.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.99
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHCCP DNSP |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$138.41 |
| Rate for Payer: Aetna Commercial |
$124.57
|
| Rate for Payer: ASR ASR |
$134.26
|
| Rate for Payer: ASR Commercial |
$134.26
|
| Rate for Payer: BCBS Trust/PPO |
$112.79
|
| Rate for Payer: BCN Commercial |
$107.31
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Healthscope Commercial |
$138.41
|
| Rate for Payer: Healthscope Whirlpool |
$134.26
|
| Rate for Payer: Mclaren Commercial |
$124.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$113.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.80
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$33.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.33
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Complete |
$19.06
|
| Rate for Payer: BCBS MAPPO |
$33.86
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: BCN Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.86
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.86
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$18.15
|
| Rate for Payer: Mclaren Medicare |
$33.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$19.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PACE Medicare |
$32.17
|
| Rate for Payer: PACE SWMI |
$33.86
|
| Rate for Payer: PHP Commercial |
$37.25
|
| Rate for Payer: PHP Medicaid |
$18.15
|
| Rate for Payer: PHP Medicare Advantage |
$33.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Medicare |
$33.86
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: Railroad Medicare Medicare |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.86
|
| Rate for Payer: UHC Exchange |
$52.48
|
| Rate for Payer: UHC Medicare Advantage |
$33.86
|
| Rate for Payer: UHCCP DNSP |
$33.86
|
| Rate for Payer: UHCCP Medicaid |
$18.15
|
| Rate for Payer: VA VA |
$33.86
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
