|
HC DAVITA OP HEMODIALYSIS
|
Facility
|
OP
|
$855.04
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100002
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$365.78 |
| Max. Negotiated Rate |
$1,057.75 |
| Rate for Payer: Aetna Commercial |
$769.54
|
| Rate for Payer: Aetna Medicare |
$682.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$853.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$853.02
|
| Rate for Payer: ASR ASR |
$829.39
|
| Rate for Payer: ASR Commercial |
$829.39
|
| Rate for Payer: BCBS Complete |
$384.07
|
| Rate for Payer: BCBS MAPPO |
$682.42
|
| Rate for Payer: BCBS Trust/PPO |
$700.19
|
| Rate for Payer: BCN Commercial |
$662.91
|
| Rate for Payer: BCN Medicare Advantage |
$682.42
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cofinity Commercial |
$803.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.42
|
| Rate for Payer: Healthscope Commercial |
$855.04
|
| Rate for Payer: Healthscope Whirlpool |
$829.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$682.42
|
| Rate for Payer: Mclaren Commercial |
$769.54
|
| Rate for Payer: Mclaren Medicaid |
$365.78
|
| Rate for Payer: Mclaren Medicare |
$682.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.54
|
| Rate for Payer: Meridian Medicaid |
$384.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$784.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.78
|
| Rate for Payer: Nomi Health Commercial |
$701.13
|
| Rate for Payer: PACE Medicare |
$648.30
|
| Rate for Payer: PACE SWMI |
$682.42
|
| Rate for Payer: PHP Commercial |
$750.66
|
| Rate for Payer: PHP Medicaid |
$365.78
|
| Rate for Payer: PHP Medicare Advantage |
$682.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.19
|
| Rate for Payer: Priority Health Medicare |
$682.42
|
| Rate for Payer: Priority Health Narrow Network |
$599.38
|
| Rate for Payer: Railroad Medicare Medicare |
$682.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$752.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$682.42
|
| Rate for Payer: UHC Exchange |
$1,057.75
|
| Rate for Payer: UHC Medicare Advantage |
$682.42
|
| Rate for Payer: UHCCP DNSP |
$682.42
|
| Rate for Payer: UHCCP Medicaid |
$365.78
|
| Rate for Payer: VA VA |
$682.42
|
|
|
HC DAVITA OP HEMODIALYSIS
|
Facility
|
IP
|
$855.04
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100002
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$555.78 |
| Max. Negotiated Rate |
$855.04 |
| Rate for Payer: Aetna Commercial |
$769.54
|
| Rate for Payer: ASR ASR |
$829.39
|
| Rate for Payer: ASR Commercial |
$829.39
|
| Rate for Payer: BCBS Trust/PPO |
$696.77
|
| Rate for Payer: BCN Commercial |
$662.91
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cofinity Commercial |
$803.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.03
|
| Rate for Payer: Healthscope Commercial |
$855.04
|
| Rate for Payer: Healthscope Whirlpool |
$829.39
|
| Rate for Payer: Mclaren Commercial |
$769.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.78
|
| Rate for Payer: Nomi Health Commercial |
$701.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$752.44
|
|
|
HC DBL PIGTAIL BILIARY STENT
|
Facility
|
OP
|
$783.42
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$783.42 |
| Rate for Payer: Aetna Commercial |
$705.08
|
| Rate for Payer: Aetna Medicare |
$391.71
|
| Rate for Payer: ASR ASR |
$759.92
|
| Rate for Payer: ASR Commercial |
$759.92
|
| Rate for Payer: BCBS Complete |
$313.37
|
| Rate for Payer: BCBS Trust/PPO |
$641.54
|
| Rate for Payer: BCN Commercial |
$607.39
|
| Rate for Payer: Cash Price |
$626.74
|
| Rate for Payer: Cofinity Commercial |
$736.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.74
|
| Rate for Payer: Healthscope Commercial |
$783.42
|
| Rate for Payer: Healthscope Whirlpool |
$759.92
|
| Rate for Payer: Mclaren Commercial |
$705.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.91
|
| Rate for Payer: Nomi Health Commercial |
$642.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.43
|
| Rate for Payer: Priority Health Narrow Network |
$549.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.41
|
|
|
HC DBL PIGTAIL BILIARY STENT
|
Facility
|
IP
|
$783.42
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.22 |
| Max. Negotiated Rate |
$783.42 |
| Rate for Payer: Aetna Commercial |
$705.08
|
| Rate for Payer: ASR ASR |
$759.92
|
| Rate for Payer: ASR Commercial |
$759.92
|
| Rate for Payer: BCBS Trust/PPO |
$638.41
|
| Rate for Payer: BCN Commercial |
$607.39
|
| Rate for Payer: Cash Price |
$626.74
|
| Rate for Payer: Cofinity Commercial |
$736.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.74
|
| Rate for Payer: Healthscope Commercial |
$783.42
|
| Rate for Payer: Healthscope Whirlpool |
$759.92
|
| Rate for Payer: Mclaren Commercial |
$705.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.91
|
| Rate for Payer: Nomi Health Commercial |
$642.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.41
|
|
|
HC D & C
|
Facility
|
IP
|
$2,041.41
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,326.92 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.55
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC D & C
|
Facility
|
OP
|
$2,041.41
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$816.56 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: Aetna Medicare |
$1,020.71
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Complete |
$816.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.71
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,788.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
IP
|
$1,051.40
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.41 |
| Max. Negotiated Rate |
$1,051.40 |
| Rate for Payer: Aetna Commercial |
$946.26
|
| Rate for Payer: ASR ASR |
$1,019.86
|
| Rate for Payer: ASR Commercial |
$1,019.86
|
| Rate for Payer: BCBS Trust/PPO |
$856.79
|
| Rate for Payer: BCN Commercial |
$815.15
|
| Rate for Payer: Cash Price |
$841.12
|
| Rate for Payer: Cofinity Commercial |
$988.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.12
|
| Rate for Payer: Healthscope Commercial |
$1,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,019.86
|
| Rate for Payer: Mclaren Commercial |
$946.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.69
|
| Rate for Payer: Nomi Health Commercial |
$862.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.23
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
OP
|
$1,051.40
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.56 |
| Max. Negotiated Rate |
$1,051.40 |
| Rate for Payer: Aetna Commercial |
$946.26
|
| Rate for Payer: Aetna Medicare |
$525.70
|
| Rate for Payer: ASR ASR |
$1,019.86
|
| Rate for Payer: ASR Commercial |
$1,019.86
|
| Rate for Payer: BCBS Complete |
$420.56
|
| Rate for Payer: BCBS Trust/PPO |
$860.99
|
| Rate for Payer: BCN Commercial |
$815.15
|
| Rate for Payer: Cash Price |
$841.12
|
| Rate for Payer: Cofinity Commercial |
$988.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.12
|
| Rate for Payer: Healthscope Commercial |
$1,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,019.86
|
| Rate for Payer: Mclaren Commercial |
$946.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.69
|
| Rate for Payer: Nomi Health Commercial |
$862.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.24
|
| Rate for Payer: Priority Health Narrow Network |
$737.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.23
|
|
|
HC D & C POSTPARTUM
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Trust/PPO |
$6,474.81
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
|
|
HC D & C POSTPARTUM
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,506.59
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,961.87
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$5,569.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC DDAVP CMPT1
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
|
|
HC DDAVP CMPT1
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$31.52
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$26.98
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP CMPT2
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
|
|
HC DDAVP CMPT2
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$31.52
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$26.98
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.52
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$26.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: ASR Commercial |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$38.49
|
| Rate for Payer: Healthscope Whirlpool |
$37.34
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$124.64
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$124.64 |
| Rate for Payer: Aetna Commercial |
$112.18
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$120.90
|
| Rate for Payer: ASR Commercial |
$120.90
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$102.07
|
| Rate for Payer: BCN Commercial |
$96.63
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$124.64
|
| Rate for Payer: Healthscope Whirlpool |
$120.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$112.18
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.94
|
| Rate for Payer: Nomi Health Commercial |
$102.20
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.21
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$87.37
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.46
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$124.64
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$124.64 |
| Rate for Payer: Aetna Commercial |
$112.18
|
| Rate for Payer: ASR ASR |
$120.90
|
| Rate for Payer: ASR Commercial |
$120.90
|
| Rate for Payer: BCBS Trust/PPO |
$101.57
|
| Rate for Payer: BCN Commercial |
$96.63
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.71
|
| Rate for Payer: Healthscope Commercial |
$124.64
|
| Rate for Payer: Healthscope Whirlpool |
$120.90
|
| Rate for Payer: Mclaren Commercial |
$112.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.94
|
| Rate for Payer: Nomi Health Commercial |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.68
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,208.87
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.77 |
| Max. Negotiated Rate |
$2,208.87 |
| Rate for Payer: Aetna Commercial |
$1,987.98
|
| Rate for Payer: ASR ASR |
$2,142.60
|
| Rate for Payer: ASR Commercial |
$2,142.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,800.01
|
| Rate for Payer: BCN Commercial |
$1,712.54
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cofinity Commercial |
$2,076.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.10
|
| Rate for Payer: Healthscope Commercial |
$2,208.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,142.60
|
| Rate for Payer: Mclaren Commercial |
$1,987.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.54
|
| Rate for Payer: Nomi Health Commercial |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,943.81
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,208.87
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,987.98
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,142.60
|
| Rate for Payer: ASR Commercial |
$2,142.60
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.84
|
| Rate for Payer: BCN Commercial |
$1,712.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cofinity Commercial |
$2,076.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,208.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,142.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,987.98
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.54
|
| Rate for Payer: Nomi Health Commercial |
$1,811.27
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.41
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,943.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$535.18
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$481.66
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$519.12
|
| Rate for Payer: ASR Commercial |
$519.12
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$438.26
|
| Rate for Payer: BCN Commercial |
$414.93
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cofinity Commercial |
$503.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$535.18
|
| Rate for Payer: Healthscope Whirlpool |
$519.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$481.66
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.90
|
| Rate for Payer: Nomi Health Commercial |
$438.85
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.92
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$375.16
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$535.18
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.87 |
| Max. Negotiated Rate |
$535.18 |
| Rate for Payer: Aetna Commercial |
$481.66
|
| Rate for Payer: ASR ASR |
$519.12
|
| Rate for Payer: ASR Commercial |
$519.12
|
| Rate for Payer: BCBS Trust/PPO |
$436.12
|
| Rate for Payer: BCN Commercial |
$414.93
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cofinity Commercial |
$503.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.14
|
| Rate for Payer: Healthscope Commercial |
$535.18
|
| Rate for Payer: Healthscope Whirlpool |
$519.12
|
| Rate for Payer: Mclaren Commercial |
$481.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.90
|
| Rate for Payer: Nomi Health Commercial |
$438.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.96
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: Aetna Medicare |
$496.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.23
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$496.66
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Commercial |
$546.33
|
| Rate for Payer: PHP Medicaid |
$266.21
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.14
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Priority Health Narrow Network |
$940.97
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP DNSP |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.86
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,657.20
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$662.88 |
| Max. Negotiated Rate |
$1,657.20 |
| Rate for Payer: Aetna Commercial |
$1,491.48
|
| Rate for Payer: Aetna Medicare |
$828.60
|
| Rate for Payer: ASR ASR |
$1,607.48
|
| Rate for Payer: ASR Commercial |
$1,607.48
|
| Rate for Payer: BCBS Complete |
$662.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.08
|
| Rate for Payer: BCN Commercial |
$1,284.83
|
| Rate for Payer: Cash Price |
$1,325.76
|
| Rate for Payer: Cofinity Commercial |
$1,557.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.76
|
| Rate for Payer: Healthscope Commercial |
$1,657.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,607.48
|
| Rate for Payer: Mclaren Commercial |
$1,491.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.62
|
| Rate for Payer: Nomi Health Commercial |
$1,358.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,452.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,458.34
|
|
