|
HC VERTEBROPLASTY CEMENT
|
Facility
|
IP
|
$1,251.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.16 |
| Max. Negotiated Rate |
$1,251.02 |
| Rate for Payer: Aetna Commercial |
$1,125.92
|
| Rate for Payer: ASR ASR |
$1,213.49
|
| Rate for Payer: ASR Commercial |
$1,213.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.46
|
| Rate for Payer: BCN Commercial |
$969.92
|
| Rate for Payer: Cash Price |
$1,000.82
|
| Rate for Payer: Cofinity Commercial |
$1,175.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.82
|
| Rate for Payer: Healthscope Commercial |
$1,251.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,213.49
|
| Rate for Payer: Mclaren Commercial |
$1,125.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.37
|
| Rate for Payer: Nomi Health Commercial |
$1,025.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.90
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
OP
|
$1,251.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.41 |
| Max. Negotiated Rate |
$1,251.02 |
| Rate for Payer: Aetna Commercial |
$1,125.92
|
| Rate for Payer: Aetna Medicare |
$625.51
|
| Rate for Payer: ASR ASR |
$1,213.49
|
| Rate for Payer: ASR Commercial |
$1,213.49
|
| Rate for Payer: BCBS Complete |
$500.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.46
|
| Rate for Payer: BCN Commercial |
$969.92
|
| Rate for Payer: Cash Price |
$1,000.82
|
| Rate for Payer: Cofinity Commercial |
$1,175.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.82
|
| Rate for Payer: Healthscope Commercial |
$1,251.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,213.49
|
| Rate for Payer: Mclaren Commercial |
$1,125.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.37
|
| Rate for Payer: Nomi Health Commercial |
$1,025.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,096.14
|
| Rate for Payer: Priority Health Narrow Network |
$876.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.90
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$6,262.84
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,070.85 |
| Max. Negotiated Rate |
$6,262.84 |
| Rate for Payer: Aetna Commercial |
$5,636.56
|
| Rate for Payer: ASR ASR |
$6,074.95
|
| Rate for Payer: ASR Commercial |
$6,074.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,103.59
|
| Rate for Payer: BCN Commercial |
$4,855.58
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cofinity Commercial |
$5,887.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.27
|
| Rate for Payer: Healthscope Commercial |
$6,262.84
|
| Rate for Payer: Healthscope Whirlpool |
$6,074.95
|
| Rate for Payer: Mclaren Commercial |
$5,636.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.41
|
| Rate for Payer: Nomi Health Commercial |
$5,135.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,511.30
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$6,262.84
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$5,636.56
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$6,074.95
|
| Rate for Payer: ASR Commercial |
$6,074.95
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$5,128.64
|
| Rate for Payer: BCN Commercial |
$4,855.58
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cofinity Commercial |
$5,887.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$6,262.84
|
| Rate for Payer: Healthscope Whirlpool |
$6,074.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$5,636.56
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.41
|
| Rate for Payer: Nomi Health Commercial |
$5,135.53
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,487.50
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$4,390.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,511.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$5,010.27
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,256.68 |
| Max. Negotiated Rate |
$5,010.27 |
| Rate for Payer: Aetna Commercial |
$4,509.24
|
| Rate for Payer: ASR ASR |
$4,859.96
|
| Rate for Payer: ASR Commercial |
$4,859.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,082.87
|
| Rate for Payer: BCN Commercial |
$3,884.46
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cofinity Commercial |
$4,709.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,008.22
|
| Rate for Payer: Healthscope Commercial |
$5,010.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,859.96
|
| Rate for Payer: Mclaren Commercial |
$4,509.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,258.73
|
| Rate for Payer: Nomi Health Commercial |
$4,108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,256.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,409.04
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$5,010.27
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,256.68 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$4,509.24
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$4,859.96
|
| Rate for Payer: ASR Commercial |
$4,859.96
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,102.91
|
| Rate for Payer: BCN Commercial |
$3,884.46
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cofinity Commercial |
$4,709.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,008.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$5,010.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,859.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$4,509.24
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,258.73
|
| Rate for Payer: Nomi Health Commercial |
$4,108.42
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,256.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,390.00
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$3,512.20
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,409.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$418.24
|
| Rate for Payer: Aetna Medicare |
$232.35
|
| Rate for Payer: ASR ASR |
$450.77
|
| Rate for Payer: ASR Commercial |
$450.77
|
| Rate for Payer: BCBS Complete |
$185.88
|
| Rate for Payer: BCBS Trust/PPO |
$380.55
|
| Rate for Payer: BCN Commercial |
$360.29
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$436.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Healthscope Commercial |
$464.71
|
| Rate for Payer: Healthscope Whirlpool |
$450.77
|
| Rate for Payer: Mclaren Commercial |
$418.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: Nomi Health Commercial |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.18
|
| Rate for Payer: Priority Health Narrow Network |
$325.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.94
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$418.24
|
| Rate for Payer: ASR ASR |
$450.77
|
| Rate for Payer: ASR Commercial |
$450.77
|
| Rate for Payer: BCBS Trust/PPO |
$378.69
|
| Rate for Payer: BCN Commercial |
$360.29
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$436.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Healthscope Commercial |
$464.71
|
| Rate for Payer: Healthscope Whirlpool |
$450.77
|
| Rate for Payer: Mclaren Commercial |
$418.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: Nomi Health Commercial |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.94
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,274.10 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Aetna Commercial |
$7,302.60
|
| Rate for Payer: ASR ASR |
$7,870.58
|
| Rate for Payer: ASR Commercial |
$7,870.58
|
| Rate for Payer: BCBS Trust/PPO |
$6,612.10
|
| Rate for Payer: BCN Commercial |
$6,290.78
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$7,627.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Healthscope Commercial |
$8,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,870.58
|
| Rate for Payer: Mclaren Commercial |
$7,302.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: Nomi Health Commercial |
$6,653.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,140.32
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,245.60 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Aetna Commercial |
$7,302.60
|
| Rate for Payer: Aetna Medicare |
$4,057.00
|
| Rate for Payer: ASR ASR |
$7,870.58
|
| Rate for Payer: ASR Commercial |
$7,870.58
|
| Rate for Payer: BCBS Complete |
$3,245.60
|
| Rate for Payer: BCBS Trust/PPO |
$6,644.55
|
| Rate for Payer: BCN Commercial |
$6,290.78
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$7,627.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Healthscope Commercial |
$8,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,870.58
|
| Rate for Payer: Mclaren Commercial |
$7,302.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: Nomi Health Commercial |
$6,653.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,109.49
|
| Rate for Payer: Priority Health Narrow Network |
$5,687.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,140.32
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: ASR Commercial |
$68.63
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$54.85
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Healthscope Whirlpool |
$68.63
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: ASR Commercial |
$68.63
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$57.94
|
| Rate for Payer: BCN Commercial |
$54.85
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Healthscope Whirlpool |
$68.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.67
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$6.26
|
| Rate for Payer: Mclaren Medicare |
$11.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$6.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: PACE Medicare |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: PHP Medicaid |
$6.26
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.99
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: Priority Health Narrow Network |
$49.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.67
|
| Rate for Payer: UHC Exchange |
$18.09
|
| Rate for Payer: UHC Medicare Advantage |
$11.67
|
| Rate for Payer: UHCCP DNSP |
$11.67
|
| Rate for Payer: UHCCP Medicaid |
$6.26
|
| Rate for Payer: VA VA |
$11.67
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.49
|
| Rate for Payer: Priority Health Narrow Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna Commercial |
$35.76
|
| Rate for Payer: ASR ASR |
$38.54
|
| Rate for Payer: ASR Commercial |
$38.54
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$37.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$39.73
|
| Rate for Payer: Healthscope Whirlpool |
$38.54
|
| Rate for Payer: Mclaren Commercial |
$35.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$32.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.96
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna Commercial |
$35.76
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: ASR ASR |
$38.54
|
| Rate for Payer: ASR Commercial |
$38.54
|
| Rate for Payer: BCBS Complete |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$32.53
|
| Rate for Payer: BCN Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$37.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$39.73
|
| Rate for Payer: Healthscope Whirlpool |
$38.54
|
| Rate for Payer: Mclaren Commercial |
$35.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$32.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.96
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$148.73
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$268.05 |
| Rate for Payer: Aetna Commercial |
$241.25
|
| Rate for Payer: ASR ASR |
$260.01
|
| Rate for Payer: ASR Commercial |
$260.01
|
| Rate for Payer: BCBS Trust/PPO |
$218.43
|
| Rate for Payer: BCN Commercial |
$207.82
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Healthscope Commercial |
$268.05
|
| Rate for Payer: Healthscope Whirlpool |
$260.01
|
| Rate for Payer: Mclaren Commercial |
$241.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.88
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$268.05 |
| Rate for Payer: Aetna Commercial |
$241.25
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$260.01
|
| Rate for Payer: ASR Commercial |
$260.01
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$219.51
|
| Rate for Payer: BCN Commercial |
$207.82
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$268.05
|
| Rate for Payer: Healthscope Whirlpool |
$260.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$241.25
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.87
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$187.90
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.51
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.61
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$6.22
|
| Rate for Payer: Mclaren Medicare |
$11.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.19
|
| Rate for Payer: Meridian Medicaid |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Medicare |
$11.03
|
| Rate for Payer: PACE SWMI |
$11.61
|
| Rate for Payer: PHP Commercial |
$12.77
|
| Rate for Payer: PHP Medicaid |
$6.22
|
| Rate for Payer: PHP Medicare Advantage |
$11.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.02
|
| Rate for Payer: Priority Health Medicare |
$11.61
|
| Rate for Payer: Priority Health Narrow Network |
$32.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.61
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.61
|
| Rate for Payer: UHCCP DNSP |
$11.61
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$11.61
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.08
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
IP
|
$188.45
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.49 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Aetna Commercial |
$169.60
|
| Rate for Payer: ASR ASR |
$182.80
|
| Rate for Payer: ASR Commercial |
$182.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.57
|
| Rate for Payer: BCN Commercial |
$146.11
|
| Rate for Payer: Cash Price |
$150.76
|
| Rate for Payer: Cofinity Commercial |
$177.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.76
|
| Rate for Payer: Healthscope Commercial |
$188.45
|
| Rate for Payer: Healthscope Whirlpool |
$182.80
|
| Rate for Payer: Mclaren Commercial |
$169.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.18
|
| Rate for Payer: Nomi Health Commercial |
$154.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.84
|
|
