|
HC DIFFUSION
|
Facility
|
OP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$396.56 |
| Rate for Payer: Aetna Commercial |
$356.90
|
| Rate for Payer: Aetna Medicare |
$198.28
|
| Rate for Payer: ASR ASR |
$384.66
|
| Rate for Payer: ASR Commercial |
$384.66
|
| Rate for Payer: BCBS Complete |
$158.62
|
| Rate for Payer: BCBS Trust/PPO |
$324.74
|
| Rate for Payer: BCN Commercial |
$307.45
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$372.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$396.56
|
| Rate for Payer: Healthscope Whirlpool |
$384.66
|
| Rate for Payer: Mclaren Commercial |
$356.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: Nomi Health Commercial |
$325.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.21
|
| Rate for Payer: Priority Health Narrow Network |
$172.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.97
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$169.32 |
| Rate for Payer: Aetna Commercial |
$152.39
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: ASR ASR |
$164.24
|
| Rate for Payer: ASR Commercial |
$164.24
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.66
|
| Rate for Payer: BCN Commercial |
$131.27
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$159.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$169.32
|
| Rate for Payer: Healthscope Whirlpool |
$164.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.81
|
| Rate for Payer: Mclaren Commercial |
$152.39
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: PHP Medicaid |
$18.66
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.36
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$118.69
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.81
|
| Rate for Payer: UHC Exchange |
$53.96
|
| Rate for Payer: UHC Medicare Advantage |
$34.81
|
| Rate for Payer: UHCCP DNSP |
$34.81
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$169.32 |
| Rate for Payer: Aetna Commercial |
$152.39
|
| Rate for Payer: ASR ASR |
$164.24
|
| Rate for Payer: ASR Commercial |
$164.24
|
| Rate for Payer: BCBS Trust/PPO |
$137.98
|
| Rate for Payer: BCN Commercial |
$131.27
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$159.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$169.32
|
| Rate for Payer: Healthscope Whirlpool |
$164.24
|
| Rate for Payer: Mclaren Commercial |
$152.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.00
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| 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 DIGOXIN LVL
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: ASR ASR |
$89.11
|
| Rate for Payer: ASR Commercial |
$89.11
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$75.23
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| 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 |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Whirlpool |
$89.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$82.68
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: PHP Medicaid |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$52.26
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Exchange |
$20.58
|
| Rate for Payer: UHC Medicare Advantage |
$13.28
|
| Rate for Payer: UHCCP DNSP |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$7.12
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$77.96 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.96
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$62.37
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Complete |
$7.74
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$86.53
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.76
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Mclaren Medicaid |
$7.38
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$15.14
|
| Rate for Payer: PHP Medicaid |
$7.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.26
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow Network |
$65.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.76
|
| Rate for Payer: UHC Exchange |
$21.33
|
| Rate for Payer: UHC Medicare Advantage |
$13.76
|
| Rate for Payer: UHCCP DNSP |
$13.76
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$153.10
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$165.01
|
| Rate for Payer: ASR Commercial |
$165.01
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$139.30
|
| Rate for Payer: BCN Commercial |
$131.89
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$159.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$170.11
|
| Rate for Payer: Healthscope Whirlpool |
$165.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$153.10
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$139.49
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.05
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$119.25
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$170.11 |
| Rate for Payer: Aetna Commercial |
$153.10
|
| Rate for Payer: ASR ASR |
$165.01
|
| Rate for Payer: ASR Commercial |
$165.01
|
| Rate for Payer: BCBS Trust/PPO |
$138.62
|
| Rate for Payer: BCN Commercial |
$131.89
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$159.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$170.11
|
| Rate for Payer: Healthscope Whirlpool |
$165.01
|
| Rate for Payer: Mclaren Commercial |
$153.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$139.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.70
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$596.17
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: ASR ASR |
$642.54
|
| Rate for Payer: ASR Commercial |
$642.54
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: BCBS Trust/PPO |
$542.45
|
| Rate for Payer: BCN Commercial |
$513.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Healthscope Whirlpool |
$642.54
|
| Rate for Payer: Mclaren Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.40
|
| Rate for Payer: Priority Health Narrow Network |
$464.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.92
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$596.17
|
| Rate for Payer: ASR ASR |
$642.54
|
| Rate for Payer: ASR Commercial |
$642.54
|
| Rate for Payer: BCBS Trust/PPO |
$539.80
|
| Rate for Payer: BCN Commercial |
$513.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Healthscope Whirlpool |
$642.54
|
| Rate for Payer: Mclaren Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.92
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,380.95 |
| Max. Negotiated Rate |
$3,663.00 |
| Rate for Payer: Aetna Commercial |
$3,296.70
|
| Rate for Payer: ASR ASR |
$3,553.11
|
| Rate for Payer: ASR Commercial |
$3,553.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,984.98
|
| Rate for Payer: BCN Commercial |
$2,839.92
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,443.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Healthscope Commercial |
$3,663.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,553.11
|
| Rate for Payer: Mclaren Commercial |
$3,296.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: Nomi Health Commercial |
$3,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,223.44
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,380.95 |
| Max. Negotiated Rate |
$15,811.10 |
| Rate for Payer: Aetna Commercial |
$3,296.70
|
| 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 |
$3,553.11
|
| Rate for Payer: ASR Commercial |
$3,553.11
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,999.63
|
| Rate for Payer: BCN Commercial |
$2,839.92
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,443.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Healthscope Commercial |
$3,663.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,553.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,200.71
|
| Rate for Payer: Mclaren Commercial |
$3,296.70
|
| 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 |
$3,113.55
|
| Rate for Payer: Nomi Health Commercial |
$3,003.66
|
| 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 |
$2,380.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,209.52
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,567.76
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,223.44
|
| 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 DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,263.68 |
| Max. Negotiated Rate |
$1,944.12 |
| Rate for Payer: Aetna Commercial |
$1,749.71
|
| Rate for Payer: ASR ASR |
$1,885.80
|
| Rate for Payer: ASR Commercial |
$1,885.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,584.26
|
| Rate for Payer: BCN Commercial |
$1,507.28
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,827.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Healthscope Commercial |
$1,944.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.80
|
| Rate for Payer: Mclaren Commercial |
$1,749.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.83
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,263.68 |
| Max. Negotiated Rate |
$5,359.44 |
| Rate for Payer: Aetna Commercial |
$1,749.71
|
| Rate for Payer: Aetna Medicare |
$3,457.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: ASR ASR |
$1,885.80
|
| Rate for Payer: ASR Commercial |
$1,885.80
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,592.04
|
| Rate for Payer: BCN Commercial |
$1,507.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,827.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$1,944.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,457.70
|
| Rate for Payer: Mclaren Commercial |
$1,749.71
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$3,803.47
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,703.44
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,362.83
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$5,359.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP DNSP |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,163.24 |
| Max. Negotiated Rate |
$7,943.45 |
| Rate for Payer: Aetna Commercial |
$7,149.10
|
| Rate for Payer: ASR ASR |
$7,705.15
|
| Rate for Payer: ASR Commercial |
$7,705.15
|
| Rate for Payer: BCBS Trust/PPO |
$6,473.12
|
| Rate for Payer: BCN Commercial |
$6,158.56
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$7,466.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Healthscope Commercial |
$7,943.45
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.15
|
| Rate for Payer: Mclaren Commercial |
$7,149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.24
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$7,943.45 |
| Rate for Payer: Aetna Commercial |
$7,149.10
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$7,705.15
|
| Rate for Payer: ASR Commercial |
$7,705.15
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$6,504.89
|
| Rate for Payer: BCN Commercial |
$6,158.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$7,466.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,943.45
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$7,149.10
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,960.05
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$5,568.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$237.62 |
| Rate for Payer: Aetna Commercial |
$194.32
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$209.43
|
| Rate for Payer: ASR Commercial |
$209.43
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.81
|
| Rate for Payer: BCN Commercial |
$167.40
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$215.91
|
| Rate for Payer: Healthscope Whirlpool |
$209.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$194.32
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.18
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$151.35
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.34 |
| Max. Negotiated Rate |
$215.91 |
| Rate for Payer: Aetna Commercial |
$194.32
|
| Rate for Payer: ASR ASR |
$209.43
|
| Rate for Payer: ASR Commercial |
$209.43
|
| Rate for Payer: BCBS Trust/PPO |
$175.95
|
| Rate for Payer: BCN Commercial |
$167.40
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Healthscope Commercial |
$215.91
|
| Rate for Payer: Healthscope Whirlpool |
$209.43
|
| Rate for Payer: Mclaren Commercial |
$194.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.00
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$366.59 |
| Rate for Payer: Aetna Commercial |
$329.93
|
| Rate for Payer: ASR ASR |
$355.59
|
| Rate for Payer: ASR Commercial |
$355.59
|
| Rate for Payer: BCBS Trust/PPO |
$298.73
|
| Rate for Payer: BCN Commercial |
$284.22
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$344.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$366.59
|
| Rate for Payer: Healthscope Whirlpool |
$355.59
|
| Rate for Payer: Mclaren Commercial |
$329.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.60
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$369.35 |
| Rate for Payer: Aetna Commercial |
$329.93
|
| Rate for Payer: Aetna Medicare |
$238.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: ASR ASR |
$355.59
|
| Rate for Payer: ASR Commercial |
$355.59
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$300.20
|
| Rate for Payer: BCN Commercial |
$284.22
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$344.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$366.59
|
| Rate for Payer: Healthscope Whirlpool |
$355.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.29
|
| Rate for Payer: Mclaren Commercial |
$329.93
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$262.12
|
| Rate for Payer: PHP Medicaid |
$127.72
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.21
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$256.98
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$369.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP DNSP |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Medicare |
$17.28
|
| Rate for Payer: ASR ASR |
$33.53
|
| Rate for Payer: ASR Commercial |
$33.53
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$28.31
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$32.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Healthscope Whirlpool |
$33.53
|
| Rate for Payer: Mclaren Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.29
|
| Rate for Payer: Priority Health Narrow Network |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.42
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: ASR ASR |
$33.53
|
| Rate for Payer: ASR Commercial |
$33.53
|
| Rate for Payer: BCBS Trust/PPO |
$28.17
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$32.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Healthscope Whirlpool |
$33.53
|
| Rate for Payer: Mclaren Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.42
|
|
