|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
IP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,723.00 |
| Max. Negotiated Rate |
$33,420.00 |
| Rate for Payer: Aetna Commercial |
$30,078.00
|
| Rate for Payer: ASR ASR |
$32,417.40
|
| Rate for Payer: ASR Commercial |
$32,417.40
|
| Rate for Payer: BCBS Trust/PPO |
$27,233.96
|
| Rate for Payer: BCN Commercial |
$25,910.53
|
| 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: Healthscope Commercial |
$33,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$32,417.40
|
| Rate for Payer: Mclaren Commercial |
$30,078.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: Nomi Health Commercial |
$27,404.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29,409.60
|
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.36 |
| Max. Negotiated Rate |
$2,314.40 |
| Rate for Payer: Aetna Commercial |
$2,082.96
|
| Rate for Payer: ASR ASR |
$2,244.97
|
| Rate for Payer: ASR Commercial |
$2,244.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.00
|
| Rate for Payer: BCN Commercial |
$1,794.35
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Healthscope Commercial |
$2,314.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,244.97
|
| Rate for Payer: Mclaren Commercial |
$2,082.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: Nomi Health Commercial |
$1,897.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,036.67
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.76 |
| Max. Negotiated Rate |
$2,314.40 |
| Rate for Payer: Aetna Commercial |
$2,082.96
|
| Rate for Payer: Aetna Medicare |
$1,157.20
|
| Rate for Payer: ASR ASR |
$2,244.97
|
| Rate for Payer: ASR Commercial |
$2,244.97
|
| Rate for Payer: BCBS Complete |
$925.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.26
|
| Rate for Payer: BCN Commercial |
$1,794.35
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Healthscope Commercial |
$2,314.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,244.97
|
| Rate for Payer: Mclaren Commercial |
$2,082.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: Nomi Health Commercial |
$1,897.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,027.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,622.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,036.67
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: Aetna Medicare |
$35.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Complete |
$19.88
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Mclaren Medicaid |
$18.94
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$19.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$38.86
|
| Rate for Payer: PHP Medicaid |
$18.94
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.84
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health Narrow Network |
$59.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UHCCP DNSP |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$18.94
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Aetna Medicare |
$37.46
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: ASR Commercial |
$72.66
|
| Rate for Payer: BCBS Complete |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$61.34
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Healthscope Whirlpool |
$72.66
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: ASR Commercial |
$72.66
|
| Rate for Payer: BCBS Trust/PPO |
$61.04
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Healthscope Whirlpool |
$72.66
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: ASR Commercial |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$28.82
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.37
|
| Rate for Payer: Healthscope Whirlpool |
$34.31
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: ASR Commercial |
$34.31
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$28.96
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$35.37
|
| Rate for Payer: Healthscope Whirlpool |
$34.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.62
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC VDRL TITER CSF
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$73.22
|
| Rate for Payer: ASR Commercial |
$73.22
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicaid |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.14
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$52.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: UHCCP DNSP |
$4.40
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC VDRL TITER CSF
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| Rate for Payer: ASR ASR |
$73.22
|
| Rate for Payer: ASR Commercial |
$73.22
|
| Rate for Payer: BCBS Trust/PPO |
$61.51
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
|
|
HC VEDOLIZUMAB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: ASR ASR |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.49
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
|
|
HC VEDOLIZUMAB
|
Facility
|
OP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$136.15
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
OP
|
$131.58
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$131.58 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$127.63
|
| Rate for Payer: ASR Commercial |
$127.63
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$107.75
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$131.58
|
| Rate for Payer: Healthscope Whirlpool |
$127.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$118.42
|
| Rate for Payer: Mclaren Medicaid |
$7.57
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.29
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$92.24
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: UHCCP DNSP |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.57
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
IP
|
$131.58
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.53 |
| Max. Negotiated Rate |
$131.58 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: ASR ASR |
$127.63
|
| Rate for Payer: ASR Commercial |
$127.63
|
| Rate for Payer: BCBS Trust/PPO |
$107.22
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$131.58
|
| Rate for Payer: Healthscope Whirlpool |
$127.63
|
| Rate for Payer: Mclaren Commercial |
$118.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.79
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
IP
|
$130.56
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: ASR Commercial |
$126.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.39
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.98
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
OP
|
$130.56
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: ASR Commercial |
$126.64
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.92
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.98
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
IP
|
$248.88
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: ASR Commercial |
$241.41
|
| Rate for Payer: BCBS Trust/PPO |
$202.81
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.55
|
| Rate for Payer: Nomi Health Commercial |
$204.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
OP
|
$248.88
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: ASR Commercial |
$241.41
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$203.81
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.55
|
| Rate for Payer: Nomi Health Commercial |
$204.08
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.16
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$35.33
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
IP
|
$1,021.26
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$663.82 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Trust/PPO |
$832.22
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
OP
|
$1,021.26
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$836.31
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.91
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$444.73
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
OP
|
$2,441.96
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,441.96 |
| Rate for Payer: Aetna Commercial |
$2,197.76
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$2,368.70
|
| Rate for Payer: ASR Commercial |
$2,368.70
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.72
|
| Rate for Payer: BCN Commercial |
$1,893.25
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,953.57
|
| Rate for Payer: Cash Price |
$1,953.57
|
| Rate for Payer: Cofinity Commercial |
$2,295.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,953.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,441.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,368.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$2,197.76
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,075.67
|
| Rate for Payer: Nomi Health Commercial |
$2,002.41
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.91
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$444.73
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,148.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
IP
|
$2,441.96
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,587.27 |
| Max. Negotiated Rate |
$2,441.96 |
| Rate for Payer: Aetna Commercial |
$2,197.76
|
| Rate for Payer: ASR ASR |
$2,368.70
|
| Rate for Payer: ASR Commercial |
$2,368.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.95
|
| Rate for Payer: BCN Commercial |
$1,893.25
|
| Rate for Payer: Cash Price |
$1,953.57
|
| Rate for Payer: Cofinity Commercial |
$2,295.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,953.57
|
| Rate for Payer: Healthscope Commercial |
$2,441.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,368.70
|
| Rate for Payer: Mclaren Commercial |
$2,197.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,075.67
|
| Rate for Payer: Nomi Health Commercial |
$2,002.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,148.92
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
OP
|
$1,072.90
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,072.90 |
| Rate for Payer: Aetna Commercial |
$965.61
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$1,040.71
|
| Rate for Payer: ASR Commercial |
$1,040.71
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$878.60
|
| Rate for Payer: BCN Commercial |
$831.82
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$858.32
|
| Rate for Payer: Cash Price |
$858.32
|
| Rate for Payer: Cofinity Commercial |
$1,008.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,072.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$965.61
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.96
|
| Rate for Payer: Nomi Health Commercial |
$879.78
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.73
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
IP
|
$1,072.90
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$697.38 |
| Max. Negotiated Rate |
$1,072.90 |
| Rate for Payer: Aetna Commercial |
$965.61
|
| Rate for Payer: ASR ASR |
$1,040.71
|
| Rate for Payer: ASR Commercial |
$1,040.71
|
| Rate for Payer: BCBS Trust/PPO |
$874.31
|
| Rate for Payer: BCN Commercial |
$831.82
|
| Rate for Payer: Cash Price |
$858.32
|
| Rate for Payer: Cofinity Commercial |
$1,008.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.32
|
| Rate for Payer: Healthscope Commercial |
$1,072.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.71
|
| Rate for Payer: Mclaren Commercial |
$965.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.96
|
| Rate for Payer: Nomi Health Commercial |
$879.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.15
|
|
