|
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 |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| 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 |
$59.85
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$47.88
|
| 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
|
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 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 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 |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| 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 |
$43.92
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$35.14
|
| 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
|
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
|
|
|
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 |
$42.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.32
|
| 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 CMPT
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.18
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.74
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$6.31
|
| Rate for Payer: PHP Medicaid |
$3.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.84
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow Network |
$25.47
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.74
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: UHCCP DNSP |
$5.74
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: VA VA |
$5.74
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$220.56 |
| Rate for Payer: Aetna Commercial |
$198.50
|
| Rate for Payer: Aetna Medicare |
$110.28
|
| Rate for Payer: ASR ASR |
$213.94
|
| Rate for Payer: ASR Commercial |
$213.94
|
| Rate for Payer: BCBS Complete |
$88.22
|
| Rate for Payer: BCBS Trust/PPO |
$180.62
|
| Rate for Payer: BCN Commercial |
$171.00
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$220.56
|
| Rate for Payer: Healthscope Whirlpool |
$213.94
|
| Rate for Payer: Mclaren Commercial |
$198.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: Nomi Health Commercial |
$180.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.48
|
| Rate for Payer: Priority Health Narrow Network |
$166.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.09
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.36 |
| Max. Negotiated Rate |
$220.56 |
| Rate for Payer: Aetna Commercial |
$198.50
|
| Rate for Payer: ASR ASR |
$213.94
|
| Rate for Payer: ASR Commercial |
$213.94
|
| Rate for Payer: BCBS Trust/PPO |
$179.73
|
| Rate for Payer: BCN Commercial |
$171.00
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$220.56
|
| Rate for Payer: Healthscope Whirlpool |
$213.94
|
| Rate for Payer: Mclaren Commercial |
$198.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: Nomi Health Commercial |
$180.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.09
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$36.64
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.31
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$83.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.46
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$80.58 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| Rate for Payer: ASR ASR |
$78.16
|
| Rate for Payer: ASR Commercial |
$78.16
|
| Rate for Payer: BCBS Trust/PPO |
$65.66
|
| Rate for Payer: BCN Commercial |
$62.47
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$80.58
|
| Rate for Payer: Healthscope Whirlpool |
$78.16
|
| Rate for Payer: Mclaren Commercial |
$72.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.91
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$78.16
|
| Rate for Payer: ASR Commercial |
$78.16
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$65.99
|
| Rate for Payer: BCN Commercial |
$62.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$80.58
|
| Rate for Payer: Healthscope Whirlpool |
$78.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$72.52
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.31
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$83.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Aetna Commercial |
$51.66
|
| Rate for Payer: ASR ASR |
$55.68
|
| Rate for Payer: ASR Commercial |
$55.68
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.50
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Healthscope Commercial |
$57.40
|
| Rate for Payer: Healthscope Whirlpool |
$55.68
|
| Rate for Payer: Mclaren Commercial |
$51.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.51
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Aetna Commercial |
$51.66
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$55.68
|
| Rate for Payer: ASR Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$47.00
|
| Rate for Payer: BCN Commercial |
$44.50
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$57.40
|
| Rate for Payer: Healthscope Whirlpool |
$55.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$51.66
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.29
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$40.24
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.87 |
| Max. Negotiated Rate |
$204.41 |
| Rate for Payer: Aetna Commercial |
$183.97
|
| Rate for Payer: ASR ASR |
$198.28
|
| Rate for Payer: ASR Commercial |
$198.28
|
| Rate for Payer: BCBS Trust/PPO |
$166.57
|
| Rate for Payer: BCN Commercial |
$158.48
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$192.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Healthscope Commercial |
$204.41
|
| Rate for Payer: Healthscope Whirlpool |
$198.28
|
| Rate for Payer: Mclaren Commercial |
$183.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: Nomi Health Commercial |
$167.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.88
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$204.41 |
| Rate for Payer: Aetna Commercial |
$183.97
|
| Rate for Payer: Aetna Medicare |
$102.20
|
| Rate for Payer: ASR ASR |
$198.28
|
| Rate for Payer: ASR Commercial |
$198.28
|
| Rate for Payer: BCBS Complete |
$81.76
|
| Rate for Payer: BCBS Trust/PPO |
$167.39
|
| Rate for Payer: BCN Commercial |
$158.48
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$192.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Healthscope Commercial |
$204.41
|
| Rate for Payer: Healthscope Whirlpool |
$198.28
|
| Rate for Payer: Mclaren Commercial |
$183.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: Nomi Health Commercial |
$167.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.10
|
| Rate for Payer: Priority Health Narrow Network |
$143.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.88
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
OP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$33,420.00 |
| Rate for Payer: Aetna Commercial |
$30,078.00
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$32,417.40
|
| Rate for Payer: ASR Commercial |
$32,417.40
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$27,367.64
|
| Rate for Payer: BCN Commercial |
$25,910.53
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cofinity Commercial |
$31,414.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$33,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$32,417.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$30,078.00
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: Nomi Health Commercial |
$27,404.40
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,282.60
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$23,427.42
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29,409.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
