|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,463.70
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$1,791.30 |
| Rate for Payer: Aetna Commercial |
$1,244.14
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$257.75
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cofinity Commercial |
$1,258.78
|
| Rate for Payer: Cofinity Commercial |
$1,024.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$1,317.33
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,244.14
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$1,244.14
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,791.30
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.04
|
| Rate for Payer: Priority Health SBD |
$922.13
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.83
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$111.66
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.10
|
| Rate for Payer: BCBS Complete |
$453.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Healthscope Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: PHP Commercial |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health SBD |
$714.42
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.42 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.10
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Healthscope Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: PHP Commercial |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health SBD |
$714.42
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$2.08
|
| Rate for Payer: Mclaren Medicare |
$3.80
|
| Rate for Payer: Meridian Medicaid |
$2.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.56
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: VA VA |
$3.80
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
|
|
HC MAPLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
OP
|
$6,048.60
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.98 |
| Max. Negotiated Rate |
$5,443.74 |
| Rate for Payer: Aetna Commercial |
$5,141.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,931.59
|
| Rate for Payer: BCBS Complete |
$2,419.44
|
| Rate for Payer: BCBS Trust/PPO |
$340.78
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$4,234.02
|
| Rate for Payer: Cofinity Commercial |
$5,201.80
|
| Rate for Payer: Healthscope Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,141.31
|
| Rate for Payer: PHP Commercial |
$5,141.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,234.02
|
| Rate for Payer: Priority Health SBD |
$3,810.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.88
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$278.98
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
IP
|
$6,048.60
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,810.62 |
| Max. Negotiated Rate |
$5,443.74 |
| Rate for Payer: Aetna Commercial |
$5,141.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,931.59
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$4,234.02
|
| Rate for Payer: Cofinity Commercial |
$5,201.80
|
| Rate for Payer: Healthscope Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,141.31
|
| Rate for Payer: PHP Commercial |
$5,141.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,234.02
|
| Rate for Payer: Priority Health SBD |
$3,810.62
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
OP
|
$4,311.84
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$477.41 |
| Max. Negotiated Rate |
$3,880.66 |
| Rate for Payer: Aetna Commercial |
$3,665.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,802.70
|
| Rate for Payer: BCBS Complete |
$1,724.74
|
| Rate for Payer: BCBS Trust/PPO |
$477.41
|
| Rate for Payer: Cash Price |
$3,449.47
|
| Rate for Payer: Cash Price |
$3,449.47
|
| Rate for Payer: Cofinity Commercial |
$3,018.29
|
| Rate for Payer: Cofinity Commercial |
$3,708.18
|
| Rate for Payer: Healthscope Commercial |
$3,880.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,665.06
|
| Rate for Payer: PHP Commercial |
$3,665.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.29
|
| Rate for Payer: Priority Health SBD |
$2,716.46
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
IP
|
$4,311.84
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,716.46 |
| Max. Negotiated Rate |
$3,880.66 |
| Rate for Payer: Aetna Commercial |
$3,665.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,802.70
|
| Rate for Payer: Cash Price |
$3,449.47
|
| Rate for Payer: Cofinity Commercial |
$3,018.29
|
| Rate for Payer: Cofinity Commercial |
$3,708.18
|
| Rate for Payer: Healthscope Commercial |
$3,880.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,665.06
|
| Rate for Payer: PHP Commercial |
$3,665.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.29
|
| Rate for Payer: Priority Health SBD |
$2,716.46
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,907.54 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$179.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,135.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$816.32
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Cofinity Commercial |
$5,530.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health SBD |
$4,977.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,977.00 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,135.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Cofinity Commercial |
$5,530.00
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health SBD |
$4,977.00
|
|
|
HC MASSAGE THERAPY
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.74
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.78
|
| Rate for Payer: UHC Exchange |
$29.80
|
|
|
HC MASSAGE THERAPY
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.19
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.19
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.19
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
|
|
HC MASTECTOMY SLEEVE EA $175
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.19
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
|
|
HC MASTECTOMY SLEEVE EA $175
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
|
