|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$89.11
|
| Rate for Payer: ASR Commercial |
$89.11
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$75.23
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Whirlpool |
$89.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$82.68
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.79
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$87.83
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: ASR ASR |
$89.11
|
| Rate for Payer: ASR Commercial |
$89.11
|
| Rate for Payer: BCBS Trust/PPO |
$74.86
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Whirlpool |
$89.11
|
| Rate for Payer: Mclaren Commercial |
$82.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.85
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$233.07
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$209.76
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$226.08
|
| Rate for Payer: ASR Commercial |
$226.08
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$190.86
|
| Rate for Payer: BCN Commercial |
$180.70
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cofinity Commercial |
$219.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$233.07
|
| Rate for Payer: Healthscope Whirlpool |
$226.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$209.76
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.11
|
| Rate for Payer: Nomi Health Commercial |
$191.12
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.22
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$163.38
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$233.07
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$233.07 |
| Rate for Payer: Aetna Commercial |
$209.76
|
| Rate for Payer: ASR ASR |
$226.08
|
| Rate for Payer: ASR Commercial |
$226.08
|
| Rate for Payer: BCBS Trust/PPO |
$189.93
|
| Rate for Payer: BCN Commercial |
$180.70
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cofinity Commercial |
$219.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.46
|
| Rate for Payer: Healthscope Commercial |
$233.07
|
| Rate for Payer: Healthscope Whirlpool |
$226.08
|
| Rate for Payer: Mclaren Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.11
|
| Rate for Payer: Nomi Health Commercial |
$191.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.10
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: Meridian Medicaid |
$7.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Medicaid |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.74
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health Narrow Network |
$46.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.95
|
| Rate for Payer: UHC Exchange |
$20.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.95
|
| Rate for Payer: UHCCP DNSP |
$12.95
|
| Rate for Payer: UHCCP Medicaid |
$6.94
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
|
|
HC CRP-SF
|
Facility
|
OP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$26.97
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$29.07
|
| Rate for Payer: ASR Commercial |
$29.07
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$24.54
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$29.97
|
| Rate for Payer: Healthscope Whirlpool |
$29.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$26.97
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.15
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$41.72
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Aetna Commercial |
$26.97
|
| Rate for Payer: ASR ASR |
$29.07
|
| Rate for Payer: ASR Commercial |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$24.42
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$28.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$29.97
|
| Rate for Payer: Healthscope Whirlpool |
$29.07
|
| Rate for Payer: Mclaren Commercial |
$26.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.37
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: ASR Commercial |
$692.58
|
| Rate for Payer: BCBS Trust/PPO |
$581.84
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: ASR Commercial |
$692.58
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS Trust/PPO |
$584.69
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.61
|
| Rate for Payer: Priority Health Narrow Network |
$500.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$1,135.08 |
| Rate for Payer: Aetna Commercial |
$1,021.57
|
| Rate for Payer: ASR ASR |
$1,101.03
|
| Rate for Payer: ASR Commercial |
$1,101.03
|
| Rate for Payer: BCBS Trust/PPO |
$924.98
|
| Rate for Payer: BCN Commercial |
$880.03
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$1,066.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Healthscope Commercial |
$1,135.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,101.03
|
| Rate for Payer: Mclaren Commercial |
$1,021.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: Nomi Health Commercial |
$930.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$998.87
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$223.62 |
| Max. Negotiated Rate |
$1,135.08 |
| Rate for Payer: Aetna Commercial |
$1,021.57
|
| Rate for Payer: Aetna Medicare |
$417.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.51
|
| Rate for Payer: ASR ASR |
$1,101.03
|
| Rate for Payer: ASR Commercial |
$1,101.03
|
| Rate for Payer: BCBS Complete |
$234.81
|
| Rate for Payer: BCBS MAPPO |
$417.21
|
| Rate for Payer: BCBS Trust/PPO |
$929.52
|
| Rate for Payer: BCN Commercial |
$880.03
|
| Rate for Payer: BCN Medicare Advantage |
$417.21
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$1,066.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.21
|
| Rate for Payer: Healthscope Commercial |
$1,135.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,101.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$417.21
|
| Rate for Payer: Mclaren Commercial |
$1,021.57
|
| Rate for Payer: Mclaren Medicaid |
$223.62
|
| Rate for Payer: Mclaren Medicare |
$417.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.07
|
| Rate for Payer: Meridian Medicaid |
$234.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: Nomi Health Commercial |
$930.77
|
| Rate for Payer: PACE Medicare |
$396.35
|
| Rate for Payer: PACE SWMI |
$417.21
|
| Rate for Payer: PHP Commercial |
$458.93
|
| Rate for Payer: PHP Medicaid |
$223.62
|
| Rate for Payer: PHP Medicare Advantage |
$417.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$994.56
|
| Rate for Payer: Priority Health Medicare |
$417.21
|
| Rate for Payer: Priority Health Narrow Network |
$795.69
|
| Rate for Payer: Railroad Medicare Medicare |
$417.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$998.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.21
|
| Rate for Payer: UHC Exchange |
$646.68
|
| Rate for Payer: UHC Medicare Advantage |
$417.21
|
| Rate for Payer: UHCCP DNSP |
$417.21
|
| Rate for Payer: UHCCP Medicaid |
$223.62
|
| Rate for Payer: VA VA |
$417.21
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: ASR ASR |
$123.68
|
| Rate for Payer: ASR Commercial |
$123.68
|
| Rate for Payer: BCBS Trust/PPO |
$103.90
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$127.50
|
| Rate for Payer: Healthscope Whirlpool |
$123.68
|
| Rate for Payer: Mclaren Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.20
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Medicare |
$63.75
|
| Rate for Payer: ASR ASR |
$123.68
|
| Rate for Payer: ASR Commercial |
$123.68
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$104.41
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$127.50
|
| Rate for Payer: Healthscope Whirlpool |
$123.68
|
| Rate for Payer: Mclaren Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.72
|
| Rate for Payer: Priority Health Narrow Network |
$89.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.20
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$270.95 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: ASR Commercial |
$404.33
|
| Rate for Payer: BCBS Trust/PPO |
$339.68
|
| Rate for Payer: BCN Commercial |
$323.18
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$416.84
|
| Rate for Payer: Healthscope Whirlpool |
$404.33
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$166.74 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: Aetna Medicare |
$208.42
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: ASR Commercial |
$404.33
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: BCBS Trust/PPO |
$341.35
|
| Rate for Payer: BCN Commercial |
$323.18
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$416.84
|
| Rate for Payer: Healthscope Whirlpool |
$404.33
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.24
|
| Rate for Payer: Priority Health Narrow Network |
$292.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
IP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
OP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC CRUTCHES
|
Facility
|
IP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$126.70 |
| Rate for Payer: Aetna Commercial |
$114.03
|
| Rate for Payer: ASR ASR |
$122.90
|
| Rate for Payer: ASR Commercial |
$122.90
|
| Rate for Payer: BCBS Trust/PPO |
$103.25
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$119.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Healthscope Commercial |
$126.70
|
| Rate for Payer: Healthscope Whirlpool |
$122.90
|
| Rate for Payer: Mclaren Commercial |
$114.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$103.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.50
|
|
|
HC CRUTCHES
|
Facility
|
OP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$126.70 |
| Rate for Payer: Aetna Commercial |
$114.03
|
| Rate for Payer: Aetna Medicare |
$63.35
|
| Rate for Payer: ASR ASR |
$122.90
|
| Rate for Payer: ASR Commercial |
$122.90
|
| Rate for Payer: BCBS Complete |
$50.68
|
| Rate for Payer: BCBS Trust/PPO |
$103.75
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$119.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Healthscope Commercial |
$126.70
|
| Rate for Payer: Healthscope Whirlpool |
$122.90
|
| Rate for Payer: Mclaren Commercial |
$114.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$103.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.01
|
| Rate for Payer: Priority Health Narrow Network |
$88.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.50
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
OP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,467.58 |
| Max. Negotiated Rate |
$15,811.10 |
| Rate for Payer: Aetna Commercial |
$10,873.01
|
| Rate for Payer: Aetna Medicare |
$10,200.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: ASR ASR |
$11,718.69
|
| Rate for Payer: ASR Commercial |
$11,718.69
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$9,893.23
|
| Rate for Payer: BCN Commercial |
$9,366.49
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$11,356.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Healthscope Commercial |
$12,081.12
|
| Rate for Payer: Healthscope Whirlpool |
$11,718.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,200.71
|
| Rate for Payer: Mclaren Commercial |
$10,873.01
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: Nomi Health Commercial |
$9,906.52
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Commercial |
$11,220.78
|
| Rate for Payer: PHP Medicaid |
$5,467.58
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,585.48
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,468.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,631.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$15,811.10
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP DNSP |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
IP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,852.73 |
| Max. Negotiated Rate |
$12,081.12 |
| Rate for Payer: Aetna Commercial |
$10,873.01
|
| Rate for Payer: ASR ASR |
$11,718.69
|
| Rate for Payer: ASR Commercial |
$11,718.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,844.90
|
| Rate for Payer: BCN Commercial |
$9,366.49
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$11,356.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Healthscope Commercial |
$12,081.12
|
| Rate for Payer: Healthscope Whirlpool |
$11,718.69
|
| Rate for Payer: Mclaren Commercial |
$10,873.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: Nomi Health Commercial |
$9,906.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,631.39
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
OP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,467.58 |
| Max. Negotiated Rate |
$15,811.10 |
| Rate for Payer: Aetna Commercial |
$9,476.79
|
| Rate for Payer: Aetna Medicare |
$10,200.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: ASR ASR |
$10,213.88
|
| Rate for Payer: ASR Commercial |
$10,213.88
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$8,622.83
|
| Rate for Payer: BCN Commercial |
$8,163.73
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$9,897.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Healthscope Commercial |
$10,529.77
|
| Rate for Payer: Healthscope Whirlpool |
$10,213.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,200.71
|
| Rate for Payer: Mclaren Commercial |
$9,476.79
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: Nomi Health Commercial |
$8,634.41
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Commercial |
$11,220.78
|
| Rate for Payer: PHP Medicaid |
$5,467.58
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,226.18
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$7,381.37
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,266.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$15,811.10
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP DNSP |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
IP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,844.35 |
| Max. Negotiated Rate |
$10,529.77 |
| Rate for Payer: Aetna Commercial |
$9,476.79
|
| Rate for Payer: ASR ASR |
$10,213.88
|
| Rate for Payer: ASR Commercial |
$10,213.88
|
| Rate for Payer: BCBS Trust/PPO |
$8,580.71
|
| Rate for Payer: BCN Commercial |
$8,163.73
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$9,897.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Healthscope Commercial |
$10,529.77
|
| Rate for Payer: Healthscope Whirlpool |
$10,213.88
|
| Rate for Payer: Mclaren Commercial |
$9,476.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: Nomi Health Commercial |
$8,634.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,266.20
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
OP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,106.68 |
| Max. Negotiated Rate |
$10,891.56 |
| Rate for Payer: Aetna Commercial |
$9,802.40
|
| Rate for Payer: Aetna Medicare |
$5,796.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: ASR ASR |
$10,564.81
|
| Rate for Payer: ASR Commercial |
$10,564.81
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$8,919.10
|
| Rate for Payer: BCN Commercial |
$8,444.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cofinity Commercial |
$10,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,713.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Healthscope Commercial |
$10,891.56
|
| Rate for Payer: Healthscope Whirlpool |
$10,564.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,796.05
|
| Rate for Payer: Mclaren Commercial |
$9,802.40
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: Nomi Health Commercial |
$8,931.08
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$6,375.66
|
| Rate for Payer: PHP Medicaid |
$3,106.68
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,543.18
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$7,634.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,584.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$8,983.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP DNSP |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
