|
HC CERTOLIZUMAB CMPT
|
Facility
|
IP
|
$130.56
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: ASR Commercial |
$126.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.39
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.98
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
OP
|
$130.56
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: ASR Commercial |
$126.64
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.92
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.98
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.42
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$34.93
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$5.76
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$11.81
|
| Rate for Payer: PHP Medicaid |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.74
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicare Advantage |
$10.74
|
| Rate for Payer: UHCCP DNSP |
$10.74
|
| Rate for Payer: UHCCP Medicaid |
$5.76
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC CERVILENZ
|
Facility
|
IP
|
$170.69
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.95 |
| Max. Negotiated Rate |
$170.69 |
| Rate for Payer: Aetna Commercial |
$153.62
|
| Rate for Payer: ASR ASR |
$165.57
|
| Rate for Payer: ASR Commercial |
$165.57
|
| Rate for Payer: BCBS Trust/PPO |
$139.10
|
| Rate for Payer: BCN Commercial |
$132.34
|
| Rate for Payer: Cash Price |
$136.55
|
| Rate for Payer: Cofinity Commercial |
$160.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.55
|
| Rate for Payer: Healthscope Commercial |
$170.69
|
| Rate for Payer: Healthscope Whirlpool |
$165.57
|
| Rate for Payer: Mclaren Commercial |
$153.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.09
|
| Rate for Payer: Nomi Health Commercial |
$139.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.21
|
|
|
HC CERVILENZ
|
Facility
|
OP
|
$170.69
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.28 |
| Max. Negotiated Rate |
$170.69 |
| Rate for Payer: Aetna Commercial |
$153.62
|
| Rate for Payer: Aetna Medicare |
$85.34
|
| Rate for Payer: ASR ASR |
$165.57
|
| Rate for Payer: ASR Commercial |
$165.57
|
| Rate for Payer: BCBS Complete |
$68.28
|
| Rate for Payer: BCBS Trust/PPO |
$139.78
|
| Rate for Payer: BCN Commercial |
$132.34
|
| Rate for Payer: Cash Price |
$136.55
|
| Rate for Payer: Cofinity Commercial |
$160.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.55
|
| Rate for Payer: Healthscope Commercial |
$170.69
|
| Rate for Payer: Healthscope Whirlpool |
$165.57
|
| Rate for Payer: Mclaren Commercial |
$153.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.09
|
| Rate for Payer: Nomi Health Commercial |
$139.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.56
|
| Rate for Payer: Priority Health Narrow Network |
$119.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.21
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
IP
|
$140.78
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$140.78 |
| Rate for Payer: Aetna Commercial |
$126.70
|
| Rate for Payer: ASR ASR |
$136.56
|
| Rate for Payer: ASR Commercial |
$136.56
|
| Rate for Payer: BCBS Trust/PPO |
$114.72
|
| Rate for Payer: BCN Commercial |
$109.15
|
| Rate for Payer: Cash Price |
$112.62
|
| Rate for Payer: Cofinity Commercial |
$132.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.62
|
| Rate for Payer: Healthscope Commercial |
$140.78
|
| Rate for Payer: Healthscope Whirlpool |
$136.56
|
| Rate for Payer: Mclaren Commercial |
$126.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.66
|
| Rate for Payer: Nomi Health Commercial |
$115.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.89
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
OP
|
$140.78
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$140.78 |
| Rate for Payer: Aetna Commercial |
$126.70
|
| Rate for Payer: Aetna Medicare |
$90.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$136.56
|
| Rate for Payer: ASR Commercial |
$136.56
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$115.28
|
| Rate for Payer: BCN Commercial |
$109.15
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$112.62
|
| Rate for Payer: Cash Price |
$112.62
|
| Rate for Payer: Cofinity Commercial |
$132.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$140.78
|
| Rate for Payer: Healthscope Whirlpool |
$136.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.63
|
| Rate for Payer: Mclaren Commercial |
$126.70
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.66
|
| Rate for Payer: Nomi Health Commercial |
$115.44
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$99.69
|
| Rate for Payer: PHP Medicaid |
$48.58
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.35
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$98.69
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Exchange |
$140.48
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP DNSP |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$48.58
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
IP
|
$777.71
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
OP
|
$777.71
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$311.08 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$388.86
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$311.08
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.43
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
OP
|
$22.32
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: ASR ASR |
$21.65
|
| Rate for Payer: ASR Commercial |
$21.65
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.65
|
| Rate for Payer: Mclaren Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$18.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.64
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
IP
|
$22.32
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$21.65
|
| Rate for Payer: ASR Commercial |
$21.65
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.65
|
| Rate for Payer: Mclaren Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$18.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.64
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$1,016.47
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.71 |
| Max. Negotiated Rate |
$1,016.47 |
| Rate for Payer: Aetna Commercial |
$914.82
|
| Rate for Payer: ASR ASR |
$985.98
|
| Rate for Payer: ASR Commercial |
$985.98
|
| Rate for Payer: BCBS Trust/PPO |
$828.32
|
| Rate for Payer: BCN Commercial |
$788.07
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Healthscope Commercial |
$1,016.47
|
| Rate for Payer: Healthscope Whirlpool |
$985.98
|
| Rate for Payer: Mclaren Commercial |
$914.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$833.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.49
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$1,016.47
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,016.47 |
| Rate for Payer: Aetna Commercial |
$914.82
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$985.98
|
| Rate for Payer: ASR Commercial |
$985.98
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$832.39
|
| Rate for Payer: BCN Commercial |
$788.07
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$1,016.47
|
| Rate for Payer: Healthscope Whirlpool |
$985.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$914.82
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$833.51
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.63
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$712.55
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
OP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,488.63 |
| Max. Negotiated Rate |
$3,721.58 |
| Rate for Payer: Aetna Commercial |
$3,349.42
|
| Rate for Payer: Aetna Medicare |
$1,860.79
|
| Rate for Payer: ASR ASR |
$3,609.93
|
| Rate for Payer: ASR Commercial |
$3,609.93
|
| Rate for Payer: BCBS Complete |
$1,488.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,047.60
|
| Rate for Payer: BCN Commercial |
$2,885.34
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$3,498.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,721.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,609.93
|
| Rate for Payer: Mclaren Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: Nomi Health Commercial |
$3,051.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,260.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,608.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,274.99
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
IP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,419.03 |
| Max. Negotiated Rate |
$3,721.58 |
| Rate for Payer: Aetna Commercial |
$3,349.42
|
| Rate for Payer: ASR ASR |
$3,609.93
|
| Rate for Payer: ASR Commercial |
$3,609.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,032.72
|
| Rate for Payer: BCN Commercial |
$2,885.34
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$3,498.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,721.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,609.93
|
| Rate for Payer: Mclaren Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: Nomi Health Commercial |
$3,051.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,274.99
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$267.07
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$287.84
|
| Rate for Payer: ASR Commercial |
$287.84
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$243.00
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$278.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$296.74
|
| Rate for Payer: Healthscope Whirlpool |
$287.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$267.07
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.19
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$180.95
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.88 |
| Max. Negotiated Rate |
$296.74 |
| Rate for Payer: Aetna Commercial |
$267.07
|
| Rate for Payer: ASR ASR |
$287.84
|
| Rate for Payer: ASR Commercial |
$287.84
|
| Rate for Payer: BCBS Trust/PPO |
$241.81
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$278.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Healthscope Commercial |
$296.74
|
| Rate for Payer: Healthscope Whirlpool |
$287.84
|
| Rate for Payer: Mclaren Commercial |
$267.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.13
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
OP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$1,126.02 |
| Rate for Payer: Aetna Commercial |
$1,013.42
|
| Rate for Payer: Aetna Medicare |
$324.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: ASR ASR |
$1,092.24
|
| Rate for Payer: ASR Commercial |
$1,092.24
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$922.10
|
| Rate for Payer: BCN Commercial |
$873.00
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$1,058.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$1,126.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.98
|
| Rate for Payer: Mclaren Commercial |
$1,013.42
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$357.48
|
| Rate for Payer: PHP Medicaid |
$174.19
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$986.62
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$789.34
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$503.72
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP DNSP |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
IP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$731.91 |
| Max. Negotiated Rate |
$1,126.02 |
| Rate for Payer: Aetna Commercial |
$1,013.42
|
| Rate for Payer: ASR ASR |
$1,092.24
|
| Rate for Payer: ASR Commercial |
$1,092.24
|
| Rate for Payer: BCBS Trust/PPO |
$917.59
|
| Rate for Payer: BCN Commercial |
$873.00
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$1,058.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Healthscope Commercial |
$1,126.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.24
|
| Rate for Payer: Mclaren Commercial |
$1,013.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.90
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,082.11 |
| Max. Negotiated Rate |
$3,203.25 |
| Rate for Payer: Aetna Commercial |
$2,882.92
|
| Rate for Payer: ASR ASR |
$3,107.15
|
| Rate for Payer: ASR Commercial |
$3,107.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,610.33
|
| Rate for Payer: BCN Commercial |
$2,483.48
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$3,011.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Healthscope Commercial |
$3,203.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,107.15
|
| Rate for Payer: Mclaren Commercial |
$2,882.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,818.86
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.21 |
| Max. Negotiated Rate |
$3,203.25 |
| Rate for Payer: Aetna Commercial |
$2,882.92
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$3,107.15
|
| Rate for Payer: ASR Commercial |
$3,107.15
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,623.14
|
| Rate for Payer: BCN Commercial |
$2,483.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$3,011.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$3,203.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,107.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$2,882.92
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,806.69
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,245.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,818.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.22 |
| Max. Negotiated Rate |
$1,955.95 |
| Rate for Payer: Aetna Commercial |
$1,760.36
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$1,897.27
|
| Rate for Payer: ASR Commercial |
$1,897.27
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.73
|
| Rate for Payer: BCN Commercial |
$1,516.45
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,838.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,897.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$1,760.36
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.28
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$324.22
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,271.37 |
| Max. Negotiated Rate |
$1,955.95 |
| Rate for Payer: Aetna Commercial |
$1,760.36
|
| Rate for Payer: ASR ASR |
$1,897.27
|
| Rate for Payer: ASR Commercial |
$1,897.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.90
|
| Rate for Payer: BCN Commercial |
$1,516.45
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,838.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Healthscope Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,897.27
|
| Rate for Payer: Mclaren Commercial |
$1,760.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.24
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$386.21 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Trust/PPO |
$314.72
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
|
