|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$322.41
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.69 |
| Max. Negotiated Rate |
$322.41 |
| Rate for Payer: Aetna Commercial |
$290.17
|
| Rate for Payer: ASR ASR |
$312.74
|
| Rate for Payer: BCBS Trust/PPO |
$249.96
|
| Rate for Payer: BCN Commercial |
$249.96
|
| Rate for Payer: Cash Price |
$257.93
|
| Rate for Payer: Cofinity Commercial |
$303.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.93
|
| Rate for Payer: Healthscope Commercial |
$322.41
|
| Rate for Payer: Healthscope Whirlpool |
$312.74
|
| Rate for Payer: Mclaren Commercial |
$290.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.72
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$322.41
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$322.41 |
| Rate for Payer: Aetna Commercial |
$290.17
|
| Rate for Payer: ASR ASR |
$312.74
|
| Rate for Payer: BCBS Complete |
$128.96
|
| Rate for Payer: BCBS Trust/PPO |
$249.96
|
| Rate for Payer: BCN Commercial |
$249.96
|
| Rate for Payer: Cash Price |
$257.93
|
| Rate for Payer: Cofinity Commercial |
$303.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.93
|
| Rate for Payer: Healthscope Commercial |
$322.41
|
| Rate for Payer: Healthscope Whirlpool |
$312.74
|
| Rate for Payer: Mclaren Commercial |
$290.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.39
|
| Rate for Payer: Priority Health Narrow Network |
$228.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.72
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$193.15
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$193.15 |
| Rate for Payer: Aetna Commercial |
$173.84
|
| Rate for Payer: ASR ASR |
$187.36
|
| Rate for Payer: BCBS Trust/PPO |
$149.75
|
| Rate for Payer: BCN Commercial |
$149.75
|
| Rate for Payer: Cash Price |
$154.52
|
| Rate for Payer: Cofinity Commercial |
$181.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.52
|
| Rate for Payer: Healthscope Commercial |
$193.15
|
| Rate for Payer: Healthscope Whirlpool |
$187.36
|
| Rate for Payer: Mclaren Commercial |
$173.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.97
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$193.15
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$193.15 |
| Rate for Payer: Aetna Commercial |
$173.84
|
| Rate for Payer: ASR ASR |
$187.36
|
| Rate for Payer: BCBS Complete |
$77.26
|
| Rate for Payer: BCBS Trust/PPO |
$149.75
|
| Rate for Payer: BCN Commercial |
$149.75
|
| Rate for Payer: Cash Price |
$154.52
|
| Rate for Payer: Cofinity Commercial |
$181.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.52
|
| Rate for Payer: Healthscope Commercial |
$193.15
|
| Rate for Payer: Healthscope Whirlpool |
$187.36
|
| Rate for Payer: Mclaren Commercial |
$173.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.77
|
| Rate for Payer: Priority Health Narrow Network |
$137.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.97
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.00
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.00
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.00
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$7.60
|
| Rate for Payer: PACE SWMI |
$8.00
|
| Rate for Payer: PHP Commercial |
$8.80
|
| Rate for Payer: PHP Medicaid |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.26
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$8.24
|
| Rate for Payer: VA VA |
$8.00
|
|
|
HC APTT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$34.89 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.29
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Medicaid |
$3.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.29
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.19
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC APTT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC APTT MIXING STUDY
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
HC APTT MIXING STUDY
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.18
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$69.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.99
|
| Rate for Payer: Priority Health Narrow Network |
$62.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
IP
|
$2,530.24
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,771.17 |
| Max. Negotiated Rate |
$2,530.24 |
| Rate for Payer: Aetna Commercial |
$2,277.22
|
| Rate for Payer: ASR ASR |
$2,454.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,961.70
|
| Rate for Payer: BCN Commercial |
$1,961.70
|
| Rate for Payer: Cash Price |
$2,024.19
|
| Rate for Payer: Cofinity Commercial |
$2,378.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.19
|
| Rate for Payer: Healthscope Commercial |
$2,530.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,454.33
|
| Rate for Payer: Mclaren Commercial |
$2,277.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.61
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
OP
|
$2,530.24
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,012.10 |
| Max. Negotiated Rate |
$2,530.24 |
| Rate for Payer: Aetna Commercial |
$2,277.22
|
| Rate for Payer: ASR ASR |
$2,454.33
|
| Rate for Payer: BCBS Complete |
$1,012.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,961.70
|
| Rate for Payer: BCN Commercial |
$1,961.70
|
| Rate for Payer: Cash Price |
$2,024.19
|
| Rate for Payer: Cofinity Commercial |
$2,378.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.19
|
| Rate for Payer: Healthscope Commercial |
$2,530.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,454.33
|
| Rate for Payer: Mclaren Commercial |
$2,277.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,302.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,796.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.61
|
|
