|
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 |
$222.60 |
| Max. Negotiated Rate |
$1,135.08 |
| Rate for Payer: Aetna Commercial |
$1,021.57
|
| Rate for Payer: Aetna Medicare |
$415.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: ASR ASR |
$1,101.03
|
| Rate for Payer: ASR Commercial |
$1,101.03
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCBS Trust/PPO |
$929.52
|
| Rate for Payer: BCN Commercial |
$880.03
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| 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 |
$415.29
|
| Rate for Payer: Healthscope Commercial |
$1,135.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,101.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$415.29
|
| Rate for Payer: Mclaren Commercial |
$1,021.57
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: Nomi Health Commercial |
$930.77
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Commercial |
$456.82
|
| Rate for Payer: PHP Medicaid |
$222.60
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| 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 |
$415.29
|
| Rate for Payer: Priority Health Narrow Network |
$795.69
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$998.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Exchange |
$643.70
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP DNSP |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$222.60
|
| Rate for Payer: VA VA |
$415.29
|
|
|
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 |
$123.67
|
| Rate for Payer: ASR Commercial |
$123.67
|
| 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 |
$123.67
|
| 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 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 |
$123.67
|
| Rate for Payer: ASR Commercial |
$123.67
|
| 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 |
$123.67
|
| 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 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 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 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 |
$238.43
|
| 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 |
$238.43
|
| 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 |
$107.69
|
| 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 |
$107.69
|
| 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
|
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 KIDNEY UNILATERAL
|
Facility
|
OP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$15,738.47 |
| Rate for Payer: Aetna Commercial |
$10,873.01
|
| Rate for Payer: Aetna Medicare |
$10,153.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: ASR ASR |
$11,718.69
|
| Rate for Payer: ASR Commercial |
$11,718.69
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCBS Trust/PPO |
$9,893.23
|
| Rate for Payer: BCN Commercial |
$9,366.49
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| 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 |
$10,153.85
|
| Rate for Payer: Healthscope Commercial |
$12,081.12
|
| Rate for Payer: Healthscope Whirlpool |
$11,718.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,153.85
|
| Rate for Payer: Mclaren Commercial |
$10,873.01
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| 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 |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Commercial |
$11,169.24
|
| Rate for Payer: PHP Medicaid |
$5,442.46
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| 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 |
$10,153.85
|
| Rate for Payer: Priority Health Narrow Network |
$8,468.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,631.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Exchange |
$15,738.47
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP DNSP |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,442.46
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
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 LIVER TUMOR
|
Facility
|
OP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$15,738.47 |
| Rate for Payer: Aetna Commercial |
$9,476.79
|
| Rate for Payer: Aetna Medicare |
$10,153.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: ASR ASR |
$10,213.88
|
| Rate for Payer: ASR Commercial |
$10,213.88
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCBS Trust/PPO |
$8,622.83
|
| Rate for Payer: BCN Commercial |
$8,163.73
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| 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 |
$10,153.85
|
| Rate for Payer: Healthscope Commercial |
$10,529.77
|
| Rate for Payer: Healthscope Whirlpool |
$10,213.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,153.85
|
| Rate for Payer: Mclaren Commercial |
$9,476.79
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| 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 |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Commercial |
$11,169.24
|
| Rate for Payer: PHP Medicaid |
$5,442.46
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| 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 |
$10,153.85
|
| Rate for Payer: Priority Health Narrow Network |
$7,381.37
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,266.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Exchange |
$15,738.47
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP DNSP |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,442.46
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
IP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,079.51 |
| Max. Negotiated Rate |
$10,891.56 |
| Rate for Payer: Aetna Commercial |
$9,802.40
|
| Rate for Payer: ASR ASR |
$10,564.81
|
| Rate for Payer: ASR Commercial |
$10,564.81
|
| Rate for Payer: BCBS Trust/PPO |
$8,875.53
|
| Rate for Payer: BCN Commercial |
$8,444.23
|
| 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: Healthscope Commercial |
$10,891.56
|
| Rate for Payer: Healthscope Whirlpool |
$10,564.81
|
| Rate for Payer: Mclaren Commercial |
$9,802.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: Nomi Health Commercial |
$8,931.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,584.57
|
|
|
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 |
$3,092.41 |
| Max. Negotiated Rate |
$10,891.56 |
| Rate for Payer: Aetna Commercial |
$9,802.40
|
| Rate for Payer: Aetna Medicare |
$5,769.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: ASR ASR |
$10,564.81
|
| Rate for Payer: ASR Commercial |
$10,564.81
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCBS Trust/PPO |
$8,919.10
|
| Rate for Payer: BCN Commercial |
$8,444.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| 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 |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$10,891.56
|
| Rate for Payer: Healthscope Whirlpool |
$10,564.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,769.42
|
| Rate for Payer: Mclaren Commercial |
$9,802.40
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| 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 |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$6,346.36
|
| Rate for Payer: PHP Medicaid |
$3,092.41
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| 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 |
$5,769.42
|
| Rate for Payer: Priority Health Narrow Network |
$7,634.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,584.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$8,942.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP DNSP |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
OP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,410.78 |
| Max. Negotiated Rate |
$3,526.96 |
| Rate for Payer: Aetna Commercial |
$3,174.26
|
| Rate for Payer: Aetna Medicare |
$1,763.48
|
| Rate for Payer: ASR ASR |
$3,421.15
|
| Rate for Payer: ASR Commercial |
$3,421.15
|
| Rate for Payer: BCBS Complete |
$1,410.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,888.23
|
| Rate for Payer: BCN Commercial |
$2,734.45
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$3,315.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Healthscope Commercial |
$3,526.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,421.15
|
| Rate for Payer: Mclaren Commercial |
$3,174.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: Nomi Health Commercial |
$2,892.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,090.32
|
| Rate for Payer: Priority Health Narrow Network |
$2,472.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,103.72
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
IP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,292.52 |
| Max. Negotiated Rate |
$3,526.96 |
| Rate for Payer: Aetna Commercial |
$3,174.26
|
| Rate for Payer: ASR ASR |
$3,421.15
|
| Rate for Payer: ASR Commercial |
$3,421.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,874.12
|
| Rate for Payer: BCN Commercial |
$2,734.45
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$3,315.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Healthscope Commercial |
$3,526.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,421.15
|
| Rate for Payer: Mclaren Commercial |
$3,174.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: Nomi Health Commercial |
$2,892.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,103.72
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,272.10 |
| Max. Negotiated Rate |
$8,180.24 |
| Rate for Payer: Aetna Commercial |
$7,362.22
|
| Rate for Payer: Aetna Medicare |
$4,090.12
|
| Rate for Payer: ASR ASR |
$7,934.83
|
| Rate for Payer: ASR Commercial |
$7,934.83
|
| Rate for Payer: BCBS Complete |
$3,272.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,698.80
|
| Rate for Payer: BCN Commercial |
$6,342.14
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$7,689.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Healthscope Commercial |
$8,180.24
|
| Rate for Payer: Healthscope Whirlpool |
$7,934.83
|
| Rate for Payer: Mclaren Commercial |
$7,362.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: Nomi Health Commercial |
$6,707.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,167.53
|
| Rate for Payer: Priority Health Narrow Network |
$5,734.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,198.61
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,317.16 |
| Max. Negotiated Rate |
$8,180.24 |
| Rate for Payer: Aetna Commercial |
$7,362.22
|
| Rate for Payer: ASR ASR |
$7,934.83
|
| Rate for Payer: ASR Commercial |
$7,934.83
|
| Rate for Payer: BCBS Trust/PPO |
$6,666.08
|
| Rate for Payer: BCN Commercial |
$6,342.14
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$7,689.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Healthscope Commercial |
$8,180.24
|
| Rate for Payer: Healthscope Whirlpool |
$7,934.83
|
| Rate for Payer: Mclaren Commercial |
$7,362.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: Nomi Health Commercial |
$6,707.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,198.61
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
IP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,976.91 |
| Max. Negotiated Rate |
$12,272.17 |
| Rate for Payer: Aetna Commercial |
$11,044.95
|
| Rate for Payer: ASR ASR |
$11,904.00
|
| Rate for Payer: ASR Commercial |
$11,904.00
|
| Rate for Payer: BCBS Trust/PPO |
$10,000.59
|
| Rate for Payer: BCN Commercial |
$9,514.61
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$11,535.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Healthscope Commercial |
$12,272.17
|
| Rate for Payer: Healthscope Whirlpool |
$11,904.00
|
| Rate for Payer: Mclaren Commercial |
$11,044.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: Nomi Health Commercial |
$10,063.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,799.51
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
OP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,908.87 |
| Max. Negotiated Rate |
$12,272.17 |
| Rate for Payer: Aetna Commercial |
$11,044.95
|
| Rate for Payer: Aetna Medicare |
$6,136.09
|
| Rate for Payer: ASR ASR |
$11,904.00
|
| Rate for Payer: ASR Commercial |
$11,904.00
|
| Rate for Payer: BCBS Complete |
$4,908.87
|
| Rate for Payer: BCBS Trust/PPO |
$10,049.68
|
| Rate for Payer: BCN Commercial |
$9,514.61
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$11,535.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Healthscope Commercial |
$12,272.17
|
| Rate for Payer: Healthscope Whirlpool |
$11,904.00
|
| Rate for Payer: Mclaren Commercial |
$11,044.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: Nomi Health Commercial |
$10,063.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,752.88
|
| Rate for Payer: Priority Health Narrow Network |
$8,602.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,799.51
|
|
|
HC CRYOGLOBULINS
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: ASR Commercial |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.11
|
| Rate for Payer: BCN Commercial |
$15.33
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.77
|
| Rate for Payer: Healthscope Whirlpool |
$19.18
|
| Rate for Payer: Mclaren Commercial |
$17.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
|
|
HC CRYOGLOBULINS
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: ASR Commercial |
$19.18
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$15.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$19.77
|
| Rate for Payer: Healthscope Whirlpool |
$19.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$17.79
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.21
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.32
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$13.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP DNSP |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: ASR ASR |
$22.45
|
| Rate for Payer: ASR Commercial |
$22.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.86
|
| Rate for Payer: BCN Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$23.14
|
| Rate for Payer: Healthscope Whirlpool |
$22.45
|
| Rate for Payer: Mclaren Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.36
|
|
