|
HC DIFFUSION
|
Facility
|
IP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$272.15 |
| Max. Negotiated Rate |
$388.78 |
| Rate for Payer: Aetna Commercial |
$349.90
|
| Rate for Payer: ASR ASR |
$377.12
|
| Rate for Payer: BCBS Trust/PPO |
$301.42
|
| Rate for Payer: BCN Commercial |
$301.42
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$365.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.02
|
| Rate for Payer: Healthscope Commercial |
$388.78
|
| Rate for Payer: Healthscope Whirlpool |
$377.12
|
| Rate for Payer: Mclaren Commercial |
$349.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.13
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.51 |
| Max. Negotiated Rate |
$388.78 |
| Rate for Payer: Aetna Commercial |
$349.90
|
| Rate for Payer: ASR ASR |
$377.12
|
| Rate for Payer: BCBS Complete |
$155.51
|
| Rate for Payer: BCBS Trust/PPO |
$301.42
|
| Rate for Payer: BCN Commercial |
$301.42
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$365.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.02
|
| Rate for Payer: Healthscope Commercial |
$388.78
|
| Rate for Payer: Healthscope Whirlpool |
$377.12
|
| Rate for Payer: Mclaren Commercial |
$349.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.13
|
| Rate for Payer: Priority Health Narrow Network |
$160.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.13
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: ASR ASR |
$161.02
|
| Rate for Payer: BCBS Complete |
$19.99
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$128.70
|
| Rate for Payer: BCN Commercial |
$128.70
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$166.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.81
|
| Rate for Payer: Mclaren Commercial |
$149.40
|
| Rate for Payer: Mclaren Medicaid |
$19.04
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Medicaid |
$19.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: PHP Medicaid |
$19.04
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.06
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$117.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.08
|
| Rate for Payer: UHC Medicare Advantage |
$35.85
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: ASR ASR |
$161.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.70
|
| Rate for Payer: BCN Commercial |
$128.70
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Healthscope Commercial |
$166.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.02
|
| Rate for Payer: Mclaren Commercial |
$149.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.08
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: ASR ASR |
$87.37
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$69.83
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$84.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Healthscope Whirlpool |
$87.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$81.06
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Medicaid |
$7.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: PHP Medicaid |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.26
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: ASR ASR |
$87.37
|
| Rate for Payer: BCBS Trust/PPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$84.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Healthscope Whirlpool |
$87.37
|
| Rate for Payer: Mclaren Commercial |
$81.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.26
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$72.86 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.86
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$58.29
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: Aetna Commercial |
$93.24
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: ASR ASR |
$100.49
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$80.32
|
| Rate for Payer: BCN Commercial |
$80.32
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$103.60
|
| Rate for Payer: Healthscope Whirlpool |
$100.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.76
|
| Rate for Payer: Mclaren Commercial |
$93.24
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$15.14
|
| Rate for Payer: PHP Medicaid |
$7.53
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.94
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow Network |
$60.75
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.17
|
| Rate for Payer: UHC Medicare Advantage |
$14.17
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: Aetna Commercial |
$93.24
|
| Rate for Payer: ASR ASR |
$100.49
|
| Rate for Payer: BCBS Trust/PPO |
$80.32
|
| Rate for Payer: BCN Commercial |
$80.32
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Healthscope Commercial |
$103.60
|
| Rate for Payer: Healthscope Whirlpool |
$100.49
|
| Rate for Payer: Mclaren Commercial |
$93.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.17
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$166.77 |
| Rate for Payer: Aetna Commercial |
$150.09
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$161.77
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$129.30
|
| Rate for Payer: BCN Commercial |
$129.30
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$166.77
|
| Rate for Payer: Healthscope Whirlpool |
$161.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$150.09
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.76
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$118.41
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.76
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$166.77 |
| Rate for Payer: Aetna Commercial |
$150.09
|
| Rate for Payer: ASR ASR |
$161.77
|
| Rate for Payer: BCBS Trust/PPO |
$129.30
|
| Rate for Payer: BCN Commercial |
$129.30
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$156.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.42
|
| Rate for Payer: Healthscope Commercial |
$166.77
|
| Rate for Payer: Healthscope Whirlpool |
$161.77
|
| Rate for Payer: Mclaren Commercial |
$150.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.76
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$454.59 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.77 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.97
|
| Rate for Payer: Priority Health Narrow Network |
$461.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,513.83 |
| Max. Negotiated Rate |
$11,437.32 |
| Rate for Payer: Aetna Commercial |
$3,232.06
|
| Rate for Payer: Aetna Medicare |
$9,149.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,437.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,437.32
|
| Rate for Payer: ASR ASR |
$3,483.44
|
| Rate for Payer: BCBS Complete |
$5,255.68
|
| Rate for Payer: BCBS MAPPO |
$9,149.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,784.24
|
| Rate for Payer: BCN Commercial |
$2,784.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,149.86
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$3,375.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,872.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,149.86
|
| Rate for Payer: Healthscope Commercial |
$3,591.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,483.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,149.86
|
| Rate for Payer: Mclaren Commercial |
$3,232.06
|
| Rate for Payer: Mclaren Medicaid |
$5,004.97
|
| Rate for Payer: Mclaren Medicare |
$9,149.86
|
| Rate for Payer: Meridian Medicaid |
$5,255.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,607.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,522.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,052.50
|
| Rate for Payer: PACE Medicare |
$8,692.37
|
| Rate for Payer: PACE SWMI |
$9,149.86
|
| Rate for Payer: PHP Commercial |
$10,064.85
|
| Rate for Payer: PHP Medicaid |
$5,004.97
|
| Rate for Payer: PHP Medicare Advantage |
$9,149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,004.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,513.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,267.97
|
| Rate for Payer: Priority Health Medicare |
$9,149.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,549.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9,149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,160.24
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,513.83 |
| Max. Negotiated Rate |
$3,591.18 |
| Rate for Payer: Aetna Commercial |
$3,232.06
|
| Rate for Payer: ASR ASR |
$3,483.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,784.24
|
| Rate for Payer: BCN Commercial |
$2,784.24
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$3,375.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,872.94
|
| Rate for Payer: Healthscope Commercial |
$3,591.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,483.44
|
| Rate for Payer: Mclaren Commercial |
$3,232.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,052.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,513.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,160.24
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,334.20 |
| Max. Negotiated Rate |
$1,906.00 |
| Rate for Payer: Aetna Commercial |
$1,715.40
|
| Rate for Payer: ASR ASR |
$1,848.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.72
|
| Rate for Payer: BCN Commercial |
$1,477.72
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,791.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Healthscope Commercial |
$1,906.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,848.82
|
| Rate for Payer: Mclaren Commercial |
$1,715.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,677.28
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,334.20 |
| Max. Negotiated Rate |
$3,844.02 |
| Rate for Payer: Aetna Commercial |
$1,715.40
|
| Rate for Payer: Aetna Medicare |
$3,075.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: ASR ASR |
$1,848.82
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.72
|
| Rate for Payer: BCN Commercial |
$1,477.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,791.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$1,906.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,848.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,075.22
|
| Rate for Payer: Mclaren Commercial |
$1,715.40
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$3,382.74
|
| Rate for Payer: PHP Medicaid |
$1,682.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,734.46
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,353.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,677.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,520.09 |
| Max. Negotiated Rate |
$7,787.70 |
| Rate for Payer: Aetna Commercial |
$7,008.93
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$7,554.07
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$6,037.80
|
| Rate for Payer: BCN Commercial |
$6,037.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$7,320.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,230.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$7,787.70
|
| Rate for Payer: Healthscope Whirlpool |
$7,554.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$7,008.93
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,086.81
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$5,529.27
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,853.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,451.39 |
| Max. Negotiated Rate |
$7,787.70 |
| Rate for Payer: Aetna Commercial |
$7,008.93
|
| Rate for Payer: ASR ASR |
$7,554.07
|
| Rate for Payer: BCBS Trust/PPO |
$6,037.80
|
| Rate for Payer: BCN Commercial |
$6,037.80
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$7,320.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,230.16
|
| Rate for Payer: Healthscope Commercial |
$7,787.70
|
| Rate for Payer: Healthscope Whirlpool |
$7,554.07
|
| Rate for Payer: Mclaren Commercial |
$7,008.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,853.18
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna Commercial |
$190.51
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$205.33
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$164.12
|
| Rate for Payer: BCN Commercial |
$164.12
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$198.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$211.68
|
| Rate for Payer: Healthscope Whirlpool |
$205.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$190.51
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.63
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$150.29
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.28
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.18 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna Commercial |
$190.51
|
| Rate for Payer: ASR ASR |
$205.33
|
| Rate for Payer: BCBS Trust/PPO |
$164.12
|
| Rate for Payer: BCN Commercial |
$164.12
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$198.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.34
|
| Rate for Payer: Healthscope Commercial |
$211.68
|
| Rate for Payer: Healthscope Whirlpool |
$205.33
|
| Rate for Payer: Mclaren Commercial |
$190.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.28
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.58 |
| Max. Negotiated Rate |
$359.40 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: ASR ASR |
$348.62
|
| Rate for Payer: BCBS Trust/PPO |
$278.64
|
| Rate for Payer: BCN Commercial |
$278.64
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$337.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Healthscope Commercial |
$359.40
|
| Rate for Payer: Healthscope Whirlpool |
$348.62
|
| Rate for Payer: Mclaren Commercial |
$323.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.27
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$359.40 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$348.62
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$278.64
|
| Rate for Payer: BCN Commercial |
$278.64
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$337.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$359.40
|
| Rate for Payer: Healthscope Whirlpool |
$348.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$323.46
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.05
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$255.17
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.27
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$33.89
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$30.50
|
| Rate for Payer: ASR ASR |
$32.87
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS Trust/PPO |
$26.27
|
| Rate for Payer: BCN Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Whirlpool |
$32.87
|
| Rate for Payer: Mclaren Commercial |
$30.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.84
|
| Rate for Payer: Priority Health Narrow Network |
$24.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.82
|
|
