|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$310.70 |
| Max. Negotiated Rate |
$839.72 |
| Rate for Payer: Aetna Commercial |
$755.75
|
| Rate for Payer: Aetna Medicare |
$310.70
|
| Rate for Payer: ASR ASR |
$814.53
|
| Rate for Payer: BCBS Complete |
$335.89
|
| Rate for Payer: BCBS Trust/PPO |
$692.35
|
| Rate for Payer: BCN Commercial |
$692.35
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Commercial |
$789.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Healthscope Commercial |
$814.53
|
| Rate for Payer: Healthscope Whirlpool |
$839.72
|
| Rate for Payer: Mclaren Commercial |
$755.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$671.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Nomi Health Commercial |
$688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$735.76
|
| Rate for Payer: Priority Health Narrow Network |
$588.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.95
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,259.56 |
| Max. Negotiated Rate |
$1,679.41 |
| Rate for Payer: Aetna Commercial |
$1,511.47
|
| Rate for Payer: ASR ASR |
$1,629.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.13
|
| Rate for Payer: BCN Commercial |
$1,379.13
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,578.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,629.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.41
|
| Rate for Payer: Mclaren Commercial |
$1,511.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.88
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$1,679.41 |
| Rate for Payer: Aetna Commercial |
$1,511.47
|
| Rate for Payer: Aetna Medicare |
$621.38
|
| Rate for Payer: ASR ASR |
$1,629.03
|
| Rate for Payer: BCBS Complete |
$671.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.67
|
| Rate for Payer: BCN Commercial |
$1,384.67
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,578.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,629.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.41
|
| Rate for Payer: Mclaren Commercial |
$1,511.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,343.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,471.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,177.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.88
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.51 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: BCBS Trust/PPO |
$248.02
|
| Rate for Payer: BCN Commercial |
$248.02
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$292.96
|
| Rate for Payer: Healthscope Whirlpool |
$302.02
|
| Rate for Payer: Mclaren Commercial |
$271.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: Aetna Medicare |
$111.75
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$249.02
|
| Rate for Payer: BCN Commercial |
$249.02
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$292.96
|
| Rate for Payer: Healthscope Whirlpool |
$302.02
|
| Rate for Payer: Mclaren Commercial |
$271.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: Aetna Medicare |
$111.75
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$249.02
|
| Rate for Payer: BCN Commercial |
$249.02
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$292.96
|
| Rate for Payer: Healthscope Whirlpool |
$302.02
|
| Rate for Payer: Mclaren Commercial |
$271.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.51 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: BCBS Trust/PPO |
$248.02
|
| Rate for Payer: BCN Commercial |
$248.02
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$292.96
|
| Rate for Payer: Healthscope Whirlpool |
$302.02
|
| Rate for Payer: Mclaren Commercial |
$271.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$6.91 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Healthscope Whirlpool |
$6.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.46
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: PHP Medicaid |
$2.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.62
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health Narrow Network |
$3.70
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$6.91
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP DNSP |
$4.46
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: VA VA |
$4.46
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Healthscope Whirlpool |
$6.36
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$722.21 |
| Max. Negotiated Rate |
$962.94 |
| Rate for Payer: Aetna Commercial |
$866.65
|
| Rate for Payer: ASR ASR |
$934.05
|
| Rate for Payer: BCBS Trust/PPO |
$790.77
|
| Rate for Payer: BCN Commercial |
$790.77
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Commercial |
$905.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Healthscope Commercial |
$934.05
|
| Rate for Payer: Healthscope Whirlpool |
$962.94
|
| Rate for Payer: Mclaren Commercial |
$866.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Nomi Health Commercial |
$789.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.39
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.65 |
| Max. Negotiated Rate |
$962.94 |
| Rate for Payer: Aetna Commercial |
$866.65
|
| Rate for Payer: Aetna Medicare |
$305.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.57
|
| Rate for Payer: ASR ASR |
$934.05
|
| Rate for Payer: BCBS Complete |
$167.65
|
| Rate for Payer: BCBS MAPPO |
$305.26
|
| Rate for Payer: BCBS Trust/PPO |
$793.94
|
| Rate for Payer: BCN Commercial |
$793.94
|
| Rate for Payer: BCN Medicare Advantage |
$305.26
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Commercial |
$905.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.26
|
| Rate for Payer: Healthscope Commercial |
$934.05
|
| Rate for Payer: Healthscope Whirlpool |
$962.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.26
|
| Rate for Payer: Mclaren Commercial |
$866.65
|
| Rate for Payer: Mclaren Medicaid |
$305.26
|
| Rate for Payer: Mclaren Medicare |
$305.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.52
|
| Rate for Payer: Meridian Medicaid |
$167.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$335.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Nomi Health Commercial |
$789.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PACE Medicare |
$290.00
|
| Rate for Payer: PACE SWMI |
$305.26
|
| Rate for Payer: PHP Commercial |
$335.79
|
| Rate for Payer: PHP Medicaid |
$163.62
|
| Rate for Payer: PHP Medicare Advantage |
$305.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$843.73
|
| Rate for Payer: Priority Health Medicare |
$305.26
|
| Rate for Payer: Priority Health Narrow Network |
$675.02
|
| Rate for Payer: Railroad Medicare Medicare |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.26
|
| Rate for Payer: UHC Exchange |
$473.15
|
| Rate for Payer: UHC Medicaid |
$159.65
|
| Rate for Payer: UHCCP DNSP |
$305.26
|
| Rate for Payer: UHCCP Medicaid |
$159.65
|
| Rate for Payer: VA VA |
$305.26
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$4,778.24
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$5,149.89
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,377.40
|
| Rate for Payer: BCN Commercial |
$4,377.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Commercial |
$4,990.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$5,149.89
|
| Rate for Payer: Healthscope Whirlpool |
$5,309.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$4,778.24
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Nomi Health Commercial |
$4,353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,651.89
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,721.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,672.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,981.87 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$4,778.24
|
| Rate for Payer: ASR ASR |
$5,149.89
|
| Rate for Payer: BCBS Trust/PPO |
$4,359.88
|
| Rate for Payer: BCN Commercial |
$4,359.88
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Commercial |
$4,990.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Healthscope Commercial |
$5,149.89
|
| Rate for Payer: Healthscope Whirlpool |
$5,309.16
|
| Rate for Payer: Mclaren Commercial |
$4,778.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Nomi Health Commercial |
$4,353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,672.06
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$344.43 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: Aetna Medicare |
$658.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: ASR ASR |
$828.32
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCBS Trust/PPO |
$704.07
|
| Rate for Payer: BCN Commercial |
$704.07
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Commercial |
$802.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Healthscope Commercial |
$828.32
|
| Rate for Payer: Healthscope Whirlpool |
$853.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$658.57
|
| Rate for Payer: Mclaren Commercial |
$768.55
|
| Rate for Payer: Mclaren Medicaid |
$658.57
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$361.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Nomi Health Commercial |
$700.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Commercial |
$724.43
|
| Rate for Payer: PHP Medicaid |
$352.99
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$469.70
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health Narrow Network |
$375.76
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.57
|
| Rate for Payer: UHC Exchange |
$1,020.78
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP DNSP |
$658.57
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: VA VA |
$658.57
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$640.46 |
| Max. Negotiated Rate |
$853.94 |
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: ASR ASR |
$828.32
|
| Rate for Payer: BCBS Trust/PPO |
$701.26
|
| Rate for Payer: BCN Commercial |
$701.26
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Commercial |
$802.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Healthscope Commercial |
$828.32
|
| Rate for Payer: Healthscope Whirlpool |
$853.94
|
| Rate for Payer: Mclaren Commercial |
$768.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Nomi Health Commercial |
$700.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.47
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$224.85
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: ASR ASR |
$242.34
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$205.98
|
| Rate for Payer: BCN Commercial |
$205.98
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$242.34
|
| Rate for Payer: Healthscope Whirlpool |
$249.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$224.85
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$119.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: PHP Medicaid |
$116.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health Narrow Network |
$92.01
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$338.19
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP DNSP |
$218.19
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$187.37 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna Commercial |
$224.85
|
| Rate for Payer: ASR ASR |
$242.34
|
| Rate for Payer: BCBS Trust/PPO |
$205.16
|
| Rate for Payer: BCN Commercial |
$205.16
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$242.34
|
| Rate for Payer: Healthscope Whirlpool |
$249.83
|
| Rate for Payer: Mclaren Commercial |
$224.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.85
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.59 |
| Max. Negotiated Rate |
$598.12 |
| Rate for Payer: Aetna Commercial |
$538.31
|
| Rate for Payer: ASR ASR |
$580.18
|
| Rate for Payer: BCBS Trust/PPO |
$491.18
|
| Rate for Payer: BCN Commercial |
$491.18
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Commercial |
$562.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Healthscope Commercial |
$580.18
|
| Rate for Payer: Healthscope Whirlpool |
$598.12
|
| Rate for Payer: Mclaren Commercial |
$538.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Nomi Health Commercial |
$490.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$526.35
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$598.12 |
| Rate for Payer: Aetna Commercial |
$538.31
|
| Rate for Payer: Aetna Medicare |
$132.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: ASR ASR |
$580.18
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$493.15
|
| Rate for Payer: BCN Commercial |
$493.15
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Commercial |
$562.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$580.18
|
| Rate for Payer: Healthscope Whirlpool |
$598.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.66
|
| Rate for Payer: Mclaren Commercial |
$538.31
|
| Rate for Payer: Mclaren Medicaid |
$132.66
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$72.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Nomi Health Commercial |
$490.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$145.93
|
| Rate for Payer: PHP Medicaid |
$71.11
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$524.07
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health Narrow Network |
$419.28
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$526.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$205.62
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP DNSP |
$132.66
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$573.10 |
| Rate for Payer: Aetna Commercial |
$515.79
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$555.91
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$472.52
|
| Rate for Payer: BCN Commercial |
$472.52
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Commercial |
$538.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$555.91
|
| Rate for Payer: Healthscope Whirlpool |
$573.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$515.79
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Nomi Health Commercial |
$469.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$502.15
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$401.74
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.82 |
| Max. Negotiated Rate |
$573.10 |
| Rate for Payer: Aetna Commercial |
$515.79
|
| Rate for Payer: ASR ASR |
$555.91
|
| Rate for Payer: BCBS Trust/PPO |
$470.63
|
| Rate for Payer: BCN Commercial |
$470.63
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Commercial |
$538.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Healthscope Commercial |
$555.91
|
| Rate for Payer: Healthscope Whirlpool |
$573.10
|
| Rate for Payer: Mclaren Commercial |
$515.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Nomi Health Commercial |
$469.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.33
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$87.27 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Aetna Medicare |
$32.29
|
| Rate for Payer: ASR ASR |
$84.65
|
| Rate for Payer: BCBS Complete |
$34.91
|
| Rate for Payer: BCBS Trust/PPO |
$71.95
|
| Rate for Payer: BCN Commercial |
$71.95
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Commercial |
$82.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$84.65
|
| Rate for Payer: Healthscope Whirlpool |
$87.27
|
| Rate for Payer: Mclaren Commercial |
$78.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Nomi Health Commercial |
$71.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.47
|
| Rate for Payer: Priority Health Narrow Network |
$61.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.80
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$87.27 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: ASR ASR |
$84.65
|
| Rate for Payer: BCBS Trust/PPO |
$71.67
|
| Rate for Payer: BCN Commercial |
$71.67
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Commercial |
$82.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$84.65
|
| Rate for Payer: Healthscope Whirlpool |
$87.27
|
| Rate for Payer: Mclaren Commercial |
$78.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Nomi Health Commercial |
$71.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.80
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,013.08 |
| Max. Negotiated Rate |
$17,350.78 |
| Rate for Payer: Aetna Commercial |
$15,615.70
|
| Rate for Payer: ASR ASR |
$16,830.26
|
| Rate for Payer: BCBS Trust/PPO |
$14,248.46
|
| Rate for Payer: BCN Commercial |
$14,248.46
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$16,309.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$16,830.26
|
| Rate for Payer: Healthscope Whirlpool |
$17,350.78
|
| Rate for Payer: Mclaren Commercial |
$15,615.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,268.69
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,419.79 |
| Max. Negotiated Rate |
$17,350.78 |
| Rate for Payer: Aetna Commercial |
$15,615.70
|
| Rate for Payer: Aetna Medicare |
$6,419.79
|
| Rate for Payer: ASR ASR |
$16,830.26
|
| Rate for Payer: BCBS Complete |
$6,940.31
|
| Rate for Payer: BCBS Trust/PPO |
$14,305.72
|
| Rate for Payer: BCN Commercial |
$14,305.72
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$16,309.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$16,830.26
|
| Rate for Payer: Healthscope Whirlpool |
$17,350.78
|
| Rate for Payer: Mclaren Commercial |
$15,615.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,880.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,799.08
|
| Rate for Payer: Priority Health Narrow Network |
$7,839.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,268.69
|
|
