|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$287.22
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.41 |
| Max. Negotiated Rate |
$287.22 |
| Rate for Payer: Aetna Commercial |
$258.50
|
| Rate for Payer: ASR ASR |
$278.60
|
| Rate for Payer: BCBS Trust/PPO |
$235.87
|
| Rate for Payer: BCN Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Healthscope Commercial |
$278.60
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Mclaren Commercial |
$258.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$235.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.75
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$287.22
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$258.50
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$278.60
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$236.81
|
| Rate for Payer: BCN Commercial |
$236.81
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$278.60
|
| Rate for Payer: Healthscope Whirlpool |
$287.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$258.50
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$235.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.66
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$201.34
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$180.06
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$180.06 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: ASR ASR |
$174.66
|
| Rate for Payer: BCBS Trust/PPO |
$147.87
|
| Rate for Payer: BCN Commercial |
$147.87
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Commercial |
$169.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Healthscope Commercial |
$174.66
|
| Rate for Payer: Healthscope Whirlpool |
$180.06
|
| Rate for Payer: Mclaren Commercial |
$162.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: Nomi Health Commercial |
$147.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.45
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$180.06
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$174.66
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$148.46
|
| Rate for Payer: BCN Commercial |
$148.46
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Commercial |
$169.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$174.66
|
| Rate for Payer: Healthscope Whirlpool |
$180.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$162.05
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: Nomi Health Commercial |
$147.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.04
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.77
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$126.22
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$36.19
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$36.19 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: ASR ASR |
$35.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$29.72
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$34.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.95
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Healthscope Whirlpool |
$36.19
|
| Rate for Payer: Mclaren Commercial |
$32.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.76
|
| Rate for Payer: Nomi Health Commercial |
$29.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.85
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$36.19
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$36.19 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Aetna Medicare |
$13.39
|
| Rate for Payer: ASR ASR |
$35.10
|
| Rate for Payer: BCBS Complete |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$29.84
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$34.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.95
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Healthscope Whirlpool |
$36.19
|
| Rate for Payer: Mclaren Commercial |
$32.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.76
|
| Rate for Payer: Nomi Health Commercial |
$29.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.71
|
| Rate for Payer: Priority Health Narrow Network |
$25.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.85
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,976.50
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,982.38 |
| Max. Negotiated Rate |
$3,976.50 |
| Rate for Payer: Aetna Commercial |
$3,578.85
|
| Rate for Payer: ASR ASR |
$3,857.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.50
|
| Rate for Payer: BCN Commercial |
$3,265.50
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cofinity Commercial |
$3,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,181.20
|
| Rate for Payer: Healthscope Commercial |
$3,857.20
|
| Rate for Payer: Healthscope Whirlpool |
$3,976.50
|
| Rate for Payer: Mclaren Commercial |
$3,578.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,380.03
|
| Rate for Payer: Nomi Health Commercial |
$3,260.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,982.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,499.32
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,976.50
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$4,999.51 |
| Rate for Payer: Aetna Commercial |
$3,578.85
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$3,857.20
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,278.62
|
| Rate for Payer: BCN Commercial |
$3,278.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cofinity Commercial |
$3,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,181.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$3,857.20
|
| Rate for Payer: Healthscope Whirlpool |
$3,976.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$3,578.85
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,380.03
|
| Rate for Payer: Nomi Health Commercial |
$3,260.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,982.38
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,015.25
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$3,212.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,499.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$25,160.93
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$25,160.93 |
| Rate for Payer: Aetna Commercial |
$22,644.84
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$24,406.10
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$20,745.19
|
| Rate for Payer: BCN Commercial |
$20,745.19
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cofinity Commercial |
$23,651.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,128.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$24,406.10
|
| Rate for Payer: Healthscope Whirlpool |
$25,160.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$22,644.84
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,386.79
|
| Rate for Payer: Nomi Health Commercial |
$20,631.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,870.70
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,799.08
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$7,839.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,141.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$25,160.93
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,870.70 |
| Max. Negotiated Rate |
$25,160.93 |
| Rate for Payer: Aetna Commercial |
$22,644.84
|
| Rate for Payer: ASR ASR |
$24,406.10
|
| Rate for Payer: BCBS Trust/PPO |
$20,662.16
|
| Rate for Payer: BCN Commercial |
$20,662.16
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cofinity Commercial |
$23,651.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,128.74
|
| Rate for Payer: Healthscope Commercial |
$24,406.10
|
| Rate for Payer: Healthscope Whirlpool |
$25,160.93
|
| Rate for Payer: Mclaren Commercial |
$22,644.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,386.79
|
| Rate for Payer: Nomi Health Commercial |
$20,631.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,870.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,141.62
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
IP
|
$386.77
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.08 |
| Max. Negotiated Rate |
$386.77 |
| Rate for Payer: Aetna Commercial |
$348.09
|
| Rate for Payer: ASR ASR |
$375.17
|
| Rate for Payer: BCBS Trust/PPO |
$317.62
|
| Rate for Payer: BCN Commercial |
$317.62
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.42
|
| Rate for Payer: Healthscope Commercial |
$375.17
|
| Rate for Payer: Healthscope Whirlpool |
$386.77
|
| Rate for Payer: Mclaren Commercial |
$348.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.75
|
| Rate for Payer: Nomi Health Commercial |
$317.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.36
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$386.77
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$386.77 |
| Rate for Payer: Aetna Commercial |
$348.09
|
| Rate for Payer: Aetna Medicare |
$143.10
|
| Rate for Payer: ASR ASR |
$375.17
|
| Rate for Payer: BCBS Complete |
$154.71
|
| Rate for Payer: BCBS Trust/PPO |
$318.89
|
| Rate for Payer: BCN Commercial |
$318.89
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.42
|
| Rate for Payer: Healthscope Commercial |
$375.17
|
| Rate for Payer: Healthscope Whirlpool |
$386.77
|
| Rate for Payer: Mclaren Commercial |
$348.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.75
|
| Rate for Payer: Nomi Health Commercial |
$317.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$338.89
|
| Rate for Payer: Priority Health Narrow Network |
$271.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.36
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$997.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: BCBS Complete |
$398.80
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$747.75
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$997.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: BCBS Complete |
$398.80
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$747.75
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
IP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$854.10
|
| Rate for Payer: ASR ASR |
$920.53
|
| Rate for Payer: BCBS Trust/PPO |
$779.32
|
| Rate for Payer: BCN Commercial |
$779.32
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$892.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$920.53
|
| Rate for Payer: Healthscope Whirlpool |
$949.00
|
| Rate for Payer: Mclaren Commercial |
$854.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.12
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
OP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$854.10
|
| Rate for Payer: Aetna Medicare |
$351.13
|
| Rate for Payer: ASR ASR |
$920.53
|
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: BCBS Trust/PPO |
$782.45
|
| Rate for Payer: BCN Commercial |
$782.45
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$892.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$920.53
|
| Rate for Payer: Healthscope Whirlpool |
$949.00
|
| Rate for Payer: Mclaren Commercial |
$854.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$759.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$831.51
|
| Rate for Payer: Priority Health Narrow Network |
$665.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.12
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.70 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Medicare |
$114.70
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$255.59
|
| Rate for Payer: BCN Commercial |
$255.59
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$300.70
|
| Rate for Payer: Healthscope Whirlpool |
$310.00
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.62
|
| Rate for Payer: Priority Health Narrow Network |
$217.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$325.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$325.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: BCBS Trust/PPO |
$254.57
|
| Rate for Payer: BCN Commercial |
$254.57
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$300.70
|
| Rate for Payer: Healthscope Whirlpool |
$310.00
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
|
|
HC DEVICE NOT RETURNED APNEALINK
|
Professional
|
Both
|
$870.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: BCBS Complete |
$348.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$652.50
|
|
|
HC DEVICE NOT RETURNED CADD PUMP
|
Facility
|
IP
|
$3,723.00
|
|
| Hospital Charge Code |
27000642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,792.25 |
| Max. Negotiated Rate |
$3,723.00 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: ASR ASR |
$3,611.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,057.33
|
| Rate for Payer: BCN Commercial |
$3,057.33
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,499.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Commercial |
$3,611.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,723.00
|
| Rate for Payer: Mclaren Commercial |
$3,350.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,792.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,276.24
|
|
|
HC DEVICE NOT RETURNED CADD PUMP
|
Facility
|
OP
|
$3,723.00
|
|
| Hospital Charge Code |
27000642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,377.51 |
| Max. Negotiated Rate |
$3,723.00 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Aetna Medicare |
$1,377.51
|
| Rate for Payer: ASR ASR |
$3,611.31
|
| Rate for Payer: BCBS Complete |
$1,489.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,069.61
|
| Rate for Payer: BCN Commercial |
$3,069.61
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,499.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Commercial |
$3,611.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,723.00
|
| Rate for Payer: Mclaren Commercial |
$3,350.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,978.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,792.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,262.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,609.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,276.24
|
|
|
HC DEVICE NOT RETURNED HOLTER MONITOR
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
27000705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$241.24 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Medicare |
$241.24
|
| Rate for Payer: ASR ASR |
$632.44
|
| Rate for Payer: BCBS Complete |
$260.80
|
| Rate for Payer: BCBS Trust/PPO |
$537.57
|
| Rate for Payer: BCN Commercial |
$537.57
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$612.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Healthscope Commercial |
$632.44
|
| Rate for Payer: Healthscope Whirlpool |
$652.00
|
| Rate for Payer: Mclaren Commercial |
$586.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$521.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$571.28
|
| Rate for Payer: Priority Health Narrow Network |
$457.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.76
|
|
|
HC DEVICE NOT RETURNED HOLTER MONITOR
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
27000705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: ASR ASR |
$632.44
|
| Rate for Payer: BCBS Trust/PPO |
$535.42
|
| Rate for Payer: BCN Commercial |
$535.42
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$612.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Healthscope Commercial |
$632.44
|
| Rate for Payer: Healthscope Whirlpool |
$652.00
|
| Rate for Payer: Mclaren Commercial |
$586.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.76
|
|
