|
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 |
$166.26 |
| 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 |
$145.68
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$116.55
|
| 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
|
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, 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 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 |
$130.56 |
| 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 |
$114.40
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$91.52
|
| 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
|
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 |
$218.07
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$174.46
|
| 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 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 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 |
$277.37 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$836.31
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.83
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$715.90
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 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 CONT MNTR
|
Facility
|
OP
|
$2,441.96
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,441.96 |
| Rate for Payer: Aetna Commercial |
$2,197.76
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,368.70
|
| Rate for Payer: ASR Commercial |
$2,368.70
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.72
|
| Rate for Payer: BCN Commercial |
$1,893.25
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,441.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,368.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,197.76
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| 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 |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,139.65
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,711.81
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,148.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$1,072.90 |
| Rate for Payer: Aetna Commercial |
$965.61
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,040.71
|
| Rate for Payer: ASR Commercial |
$1,040.71
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$878.60
|
| Rate for Payer: BCN Commercial |
$831.82
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,072.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$965.61
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.97
|
| Rate for Payer: Nomi Health Commercial |
$879.78
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.07
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$752.10
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$911.97
|
| 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
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
OP
|
$1,959.46
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.60
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,716.88
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.58
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
IP
|
$1,959.46
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,273.65 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: ASR ASR |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.76
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
OP
|
$4,552.18
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$4,552.18 |
| Rate for Payer: Aetna Commercial |
$4,096.96
|
| Rate for Payer: Aetna Medicare |
$992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: ASR ASR |
$4,415.61
|
| Rate for Payer: ASR Commercial |
$4,415.61
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,727.78
|
| Rate for Payer: BCN Commercial |
$3,529.31
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cofinity Commercial |
$4,279.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,641.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$4,552.18
|
| Rate for Payer: Healthscope Whirlpool |
$4,415.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$992.24
|
| Rate for Payer: Mclaren Commercial |
$4,096.96
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,869.35
|
| Rate for Payer: Nomi Health Commercial |
$3,732.79
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$1,091.46
|
| Rate for Payer: PHP Medicaid |
$531.84
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,958.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,988.62
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health Narrow Network |
$3,191.08
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,005.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$1,537.97
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP DNSP |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$531.84
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
IP
|
$4,552.18
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$4,552.18 |
| Rate for Payer: Aetna Commercial |
$4,096.96
|
| Rate for Payer: ASR ASR |
$4,415.61
|
| Rate for Payer: ASR Commercial |
$4,415.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.57
|
| Rate for Payer: BCN Commercial |
$3,529.31
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cofinity Commercial |
$4,279.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,641.74
|
| Rate for Payer: Healthscope Commercial |
$4,552.18
|
| Rate for Payer: Healthscope Whirlpool |
$4,415.61
|
| Rate for Payer: Mclaren Commercial |
$4,096.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,869.35
|
| Rate for Payer: Nomi Health Commercial |
$3,732.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,958.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,005.92
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
OP
|
$2,421.79
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,421.79 |
| Rate for Payer: Aetna Commercial |
$2,179.61
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,349.14
|
| Rate for Payer: ASR Commercial |
$2,349.14
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.20
|
| Rate for Payer: BCN Commercial |
$1,877.61
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cofinity Commercial |
$2,276.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,421.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,349.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,179.61
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,058.52
|
| Rate for Payer: Nomi Health Commercial |
$1,985.87
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,121.97
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,697.67
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,131.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
IP
|
$2,421.79
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,574.16 |
| Max. Negotiated Rate |
$2,421.79 |
| Rate for Payer: Aetna Commercial |
$2,179.61
|
| Rate for Payer: ASR ASR |
$2,349.14
|
| Rate for Payer: ASR Commercial |
$2,349.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.52
|
| Rate for Payer: BCN Commercial |
$1,877.61
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cofinity Commercial |
$2,276.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.43
|
| Rate for Payer: Healthscope Commercial |
$2,421.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,349.14
|
| Rate for Payer: Mclaren Commercial |
$2,179.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,058.52
|
| Rate for Payer: Nomi Health Commercial |
$1,985.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,131.18
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.58
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,234.29
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$987.49
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$915.65 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.94
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$915.65 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.94
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.58
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,234.29
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$987.49
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
