|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
IP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$752.56 |
| Max. Negotiated Rate |
$1,075.08 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: ASR ASR |
$1,042.83
|
| Rate for Payer: BCBS Trust/PPO |
$833.51
|
| Rate for Payer: BCN Commercial |
$833.51
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$1,010.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Healthscope Commercial |
$1,075.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.83
|
| Rate for Payer: Mclaren Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.07
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
OP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$430.03 |
| Max. Negotiated Rate |
$1,075.08 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: ASR ASR |
$1,042.83
|
| Rate for Payer: BCBS Complete |
$430.03
|
| Rate for Payer: BCBS Trust/PPO |
$833.51
|
| Rate for Payer: BCN Commercial |
$833.51
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$1,010.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Healthscope Commercial |
$1,075.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.83
|
| Rate for Payer: Mclaren Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$978.32
|
| Rate for Payer: Priority Health Narrow Network |
$763.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.07
|
|
|
HC CT FACIAL W CON
|
Facility
|
OP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,560.50 |
| Rate for Payer: Aetna Commercial |
$1,404.45
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,513.68
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.86
|
| Rate for Payer: BCN Commercial |
$1,209.86
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,466.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,560.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,513.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,404.45
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,326.42
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$853.27
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$682.62
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.24
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT FACIAL W CON
|
Facility
|
IP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,092.35 |
| Max. Negotiated Rate |
$1,560.50 |
| Rate for Payer: Aetna Commercial |
$1,404.45
|
| Rate for Payer: ASR ASR |
$1,513.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.86
|
| Rate for Payer: BCN Commercial |
$1,209.86
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,466.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.40
|
| Rate for Payer: Healthscope Commercial |
$1,560.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,513.68
|
| Rate for Payer: Mclaren Commercial |
$1,404.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,326.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.24
|
|
|
HC CT FACIAL WO CON
|
Facility
|
OP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,383.22 |
| Rate for Payer: Aetna Commercial |
$1,244.90
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,341.72
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.41
|
| Rate for Payer: BCN Commercial |
$1,072.41
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$1,300.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,383.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,244.90
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.74
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.43
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$656.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,217.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT FACIAL WO CON
|
Facility
|
IP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$968.25 |
| Max. Negotiated Rate |
$1,383.22 |
| Rate for Payer: Aetna Commercial |
$1,244.90
|
| Rate for Payer: ASR ASR |
$1,341.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.41
|
| Rate for Payer: BCN Commercial |
$1,072.41
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$1,300.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.58
|
| Rate for Payer: Healthscope Commercial |
$1,383.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.72
|
| Rate for Payer: Mclaren Commercial |
$1,244.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,217.23
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
OP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,469.30 |
| Rate for Payer: Aetna Commercial |
$1,322.37
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,425.22
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.15
|
| Rate for Payer: BCN Commercial |
$1,139.15
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,381.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,469.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,322.37
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.33
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$731.46
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
IP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,028.51 |
| Max. Negotiated Rate |
$1,469.30 |
| Rate for Payer: Aetna Commercial |
$1,322.37
|
| Rate for Payer: ASR ASR |
$1,425.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.15
|
| Rate for Payer: BCN Commercial |
$1,139.15
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,381.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Healthscope Commercial |
$1,469.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.22
|
| Rate for Payer: Mclaren Commercial |
$1,322.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.98
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$994.10 |
| Max. Negotiated Rate |
$1,420.15 |
| Rate for Payer: Aetna Commercial |
$1,278.14
|
| Rate for Payer: ASR ASR |
$1,377.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.04
|
| Rate for Payer: BCN Commercial |
$1,101.04
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Healthscope Commercial |
$1,420.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.55
|
| Rate for Payer: Mclaren Commercial |
$1,278.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.73
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$492.57 |
| Max. Negotiated Rate |
$1,420.15 |
| Rate for Payer: Aetna Commercial |
$1,278.14
|
| Rate for Payer: ASR ASR |
$1,377.55
|
| Rate for Payer: BCBS Complete |
$568.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.04
|
| Rate for Payer: BCN Commercial |
$1,101.04
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Healthscope Commercial |
$1,420.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.55
|
| Rate for Payer: Mclaren Commercial |
$1,278.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.71
|
| Rate for Payer: Priority Health Narrow Network |
$492.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.73
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$492.57 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Aetna Commercial |
$1,156.68
|
| Rate for Payer: ASR ASR |
$1,246.64
|
| Rate for Payer: BCBS Complete |
$514.08
|
| Rate for Payer: BCBS Trust/PPO |
$996.42
|
| Rate for Payer: BCN Commercial |
$996.42
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$1,208.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,028.16
|
| Rate for Payer: Healthscope Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,246.64
|
| Rate for Payer: Mclaren Commercial |
$1,156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.71
|
| Rate for Payer: Priority Health Narrow Network |
$492.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.98
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Aetna Commercial |
$1,156.68
|
| Rate for Payer: ASR ASR |
$1,246.64
|
| Rate for Payer: BCBS Trust/PPO |
$996.42
|
| Rate for Payer: BCN Commercial |
$996.42
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$1,208.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,028.16
|
| Rate for Payer: Healthscope Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,246.64
|
| Rate for Payer: Mclaren Commercial |
$1,156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.98
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$409.60 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$921.60
|
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: ASR ASR |
$993.28
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCBS Trust/PPO |
$793.91
|
| Rate for Payer: BCN Commercial |
$793.91
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Cofinity Commercial |
$962.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Healthscope Whirlpool |
$993.28
|
| Rate for Payer: Mclaren Commercial |
$921.60
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| 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 Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$727.04
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.12
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$716.80 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$921.60
|
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: ASR ASR |
$993.28
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCBS Trust/PPO |
$793.91
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: BCN Commercial |
$793.91
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Cofinity Commercial |
$962.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.20
|
| Rate for Payer: Healthscope Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$993.28
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Mclaren Commercial |
$921.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,649.90 |
| Max. Negotiated Rate |
$2,357.00 |
| Rate for Payer: Aetna Commercial |
$2,121.30
|
| Rate for Payer: Aetna Commercial |
$1,056.62
|
| Rate for Payer: ASR ASR |
$2,286.29
|
| Rate for Payer: ASR ASR |
$1,138.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.38
|
| Rate for Payer: BCBS Trust/PPO |
$910.22
|
| Rate for Payer: BCN Commercial |
$1,827.38
|
| Rate for Payer: BCN Commercial |
$910.22
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$1,103.58
|
| Rate for Payer: Cofinity Commercial |
$2,215.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.22
|
| Rate for Payer: Healthscope Commercial |
$2,357.00
|
| Rate for Payer: Healthscope Commercial |
$1,174.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,286.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,138.80
|
| Rate for Payer: Mclaren Commercial |
$1,056.62
|
| Rate for Payer: Mclaren Commercial |
$2,121.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,033.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,074.16
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,174.02
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$469.61 |
| Max. Negotiated Rate |
$1,174.02 |
| Rate for Payer: Aetna Commercial |
$1,056.62
|
| Rate for Payer: Aetna Commercial |
$2,121.30
|
| Rate for Payer: ASR ASR |
$2,286.29
|
| Rate for Payer: ASR ASR |
$1,138.80
|
| Rate for Payer: BCBS Complete |
$942.80
|
| Rate for Payer: BCBS Complete |
$469.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.38
|
| Rate for Payer: BCBS Trust/PPO |
$910.22
|
| Rate for Payer: BCN Commercial |
$910.22
|
| Rate for Payer: BCN Commercial |
$1,827.38
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$2,215.58
|
| Rate for Payer: Cofinity Commercial |
$1,103.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Healthscope Commercial |
$1,174.02
|
| Rate for Payer: Healthscope Commercial |
$2,357.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,138.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,286.29
|
| Rate for Payer: Mclaren Commercial |
$2,121.30
|
| Rate for Payer: Mclaren Commercial |
$1,056.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,144.87
|
| Rate for Payer: Priority Health Narrow Network |
$833.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,673.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,033.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,074.16
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.09
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$692.87
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$155.06
|
| Rate for Payer: BCN Commercial |
$155.06
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.93
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$123.14
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$155.06
|
| Rate for Payer: BCN Commercial |
$155.06
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$928.76 |
| Max. Negotiated Rate |
$1,326.80 |
| Rate for Payer: Aetna Commercial |
$1,194.12
|
| Rate for Payer: ASR ASR |
$1,287.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.67
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,247.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,326.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.00
|
| Rate for Payer: Mclaren Commercial |
$1,194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.58
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,326.80 |
| Rate for Payer: Aetna Commercial |
$1,194.12
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,287.00
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.67
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,247.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,326.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,194.12
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,207.39
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$942.03
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.58
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$947.34 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.24
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.24
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.54
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$960.87
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$484.16 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
|
