|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$303.68
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$447.41 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$303.68
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$303.68 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$488.86
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.20 |
| Max. Negotiated Rate |
$488.86 |
| Rate for Payer: Aetna Commercial |
$439.97
|
| Rate for Payer: ASR ASR |
$474.19
|
| Rate for Payer: BCBS Trust/PPO |
$379.01
|
| Rate for Payer: BCN Commercial |
$379.01
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$459.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.09
|
| Rate for Payer: Healthscope Commercial |
$488.86
|
| Rate for Payer: Healthscope Whirlpool |
$474.19
|
| Rate for Payer: Mclaren Commercial |
$439.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$430.20
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$488.86
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$488.86 |
| Rate for Payer: Aetna Commercial |
$439.97
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$474.19
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$379.01
|
| Rate for Payer: BCN Commercial |
$379.01
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$459.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$488.86
|
| Rate for Payer: Healthscope Whirlpool |
$474.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$439.97
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$430.20
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$447.41 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
IP
|
$303.68
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$303.68 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
OP
|
$303.68
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTMD RPR WND FACE/MM 5.1-7.5 CM
|
Facility
|
IP
|
$881.89
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
76100315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.32 |
| Max. Negotiated Rate |
$881.89 |
| Rate for Payer: Aetna Commercial |
$793.70
|
| Rate for Payer: ASR ASR |
$855.43
|
| Rate for Payer: BCBS Trust/PPO |
$683.73
|
| Rate for Payer: BCN Commercial |
$683.73
|
| Rate for Payer: Cash Price |
$705.51
|
| Rate for Payer: Cofinity Commercial |
$828.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.51
|
| Rate for Payer: Healthscope Commercial |
$881.89
|
| Rate for Payer: Healthscope Whirlpool |
$855.43
|
| Rate for Payer: Mclaren Commercial |
$793.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.06
|
|
|
HC INTMD RPR WND FACE/MM 5.1-7.5 CM
|
Facility
|
OP
|
$881.89
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
76100315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$881.89 |
| Rate for Payer: Aetna Commercial |
$793.70
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$855.43
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$683.73
|
| Rate for Payer: BCN Commercial |
$683.73
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$705.51
|
| Rate for Payer: Cash Price |
$705.51
|
| Rate for Payer: Cofinity Commercial |
$828.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$881.89
|
| Rate for Payer: Healthscope Whirlpool |
$855.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$793.70
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.61
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.06
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$2,162.55
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
36100083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$865.02 |
| Max. Negotiated Rate |
$2,162.55 |
| Rate for Payer: Aetna Commercial |
$1,946.30
|
| Rate for Payer: ASR ASR |
$2,097.67
|
| Rate for Payer: BCBS Complete |
$865.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.63
|
| Rate for Payer: BCN Commercial |
$1,676.63
|
| Rate for Payer: Cash Price |
$1,730.04
|
| Rate for Payer: Cofinity Commercial |
$2,032.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,730.04
|
| Rate for Payer: Healthscope Commercial |
$2,162.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.67
|
| Rate for Payer: Mclaren Commercial |
$1,946.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,838.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,967.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,535.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,903.04
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$2,162.55
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
36100083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,513.78 |
| Max. Negotiated Rate |
$2,162.55 |
| Rate for Payer: Aetna Commercial |
$1,946.30
|
| Rate for Payer: ASR ASR |
$2,097.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.63
|
| Rate for Payer: BCN Commercial |
$1,676.63
|
| Rate for Payer: Cash Price |
$1,730.04
|
| Rate for Payer: Cofinity Commercial |
$2,032.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,730.04
|
| Rate for Payer: Healthscope Commercial |
$2,162.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.67
|
| Rate for Payer: Mclaren Commercial |
$1,946.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,838.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,903.04
|
|
|
HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS
|
Facility
|
OP
|
$1,313.96
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
48100104
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$525.58 |
| Max. Negotiated Rate |
$1,313.96 |
| Rate for Payer: Aetna Commercial |
$1,182.56
|
| Rate for Payer: ASR ASR |
$1,274.54
|
| Rate for Payer: BCBS Complete |
$525.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.71
|
| Rate for Payer: BCN Commercial |
$1,018.71
|
| Rate for Payer: Cash Price |
$1,051.17
|
| Rate for Payer: Cofinity Commercial |
$1,235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.17
|
| Rate for Payer: Healthscope Commercial |
$1,313.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,274.54
|
| Rate for Payer: Mclaren Commercial |
$1,182.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.70
|
| Rate for Payer: Priority Health Narrow Network |
$932.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.28
|
|
|
HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS
|
Facility
|
IP
|
$1,313.96
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
48100104
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$919.77 |
| Max. Negotiated Rate |
$1,313.96 |
| Rate for Payer: Aetna Commercial |
$1,182.56
|
| Rate for Payer: ASR ASR |
$1,274.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.71
|
| Rate for Payer: BCN Commercial |
$1,018.71
|
| Rate for Payer: Cash Price |
$1,051.17
|
| Rate for Payer: Cofinity Commercial |
$1,235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.17
|
| Rate for Payer: Healthscope Commercial |
$1,313.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,274.54
|
| Rate for Payer: Mclaren Commercial |
$1,182.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.28
|
|
|
HC INTRA ART ADMIN RP PARTICULATE
|
Facility
|
OP
|
$1,052.08
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
34200001
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$1,052.08 |
| Rate for Payer: Aetna Commercial |
$946.87
|
| Rate for Payer: Aetna Medicare |
$221.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.42
|
| Rate for Payer: ASR ASR |
$1,020.52
|
| Rate for Payer: BCBS Complete |
$127.02
|
| Rate for Payer: BCBS MAPPO |
$221.14
|
| Rate for Payer: BCBS Trust/PPO |
$815.68
|
| Rate for Payer: BCN Commercial |
$815.68
|
| Rate for Payer: BCN Medicare Advantage |
$221.14
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cofinity Commercial |
$988.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.14
|
| Rate for Payer: Healthscope Commercial |
$1,052.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$221.14
|
| Rate for Payer: Mclaren Commercial |
$946.87
|
| Rate for Payer: Mclaren Medicaid |
$120.96
|
| Rate for Payer: Mclaren Medicare |
$221.14
|
| Rate for Payer: Meridian Medicaid |
$127.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.27
|
| Rate for Payer: PACE Medicare |
$210.08
|
| Rate for Payer: PACE SWMI |
$221.14
|
| Rate for Payer: PHP Commercial |
$243.25
|
| Rate for Payer: PHP Medicaid |
$120.96
|
| Rate for Payer: PHP Medicare Advantage |
$221.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.39
|
| Rate for Payer: Priority Health Medicare |
$221.14
|
| Rate for Payer: Priority Health Narrow Network |
$746.98
|
| Rate for Payer: Railroad Medicare Medicare |
$221.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.83
|
| Rate for Payer: UHC Medicare Advantage |
$227.77
|
| Rate for Payer: VA VA |
$221.14
|
|
|
HC INTRA ART ADMIN RP PARTICULATE
|
Facility
|
IP
|
$1,052.08
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
34200001
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$736.46 |
| Max. Negotiated Rate |
$1,052.08 |
| Rate for Payer: Aetna Commercial |
$946.87
|
| Rate for Payer: ASR ASR |
$1,020.52
|
| Rate for Payer: BCBS Trust/PPO |
$815.68
|
| Rate for Payer: BCN Commercial |
$815.68
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cofinity Commercial |
$988.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.66
|
| Rate for Payer: Healthscope Commercial |
$1,052.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.52
|
| Rate for Payer: Mclaren Commercial |
$946.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.83
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
OP
|
$3,086.75
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,160.72 |
| Max. Negotiated Rate |
$8,297.88 |
| Rate for Payer: Aetna Commercial |
$2,778.08
|
| Rate for Payer: Aetna Medicare |
$6,638.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,297.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,297.88
|
| Rate for Payer: ASR ASR |
$2,994.15
|
| Rate for Payer: BCBS Complete |
$3,813.04
|
| Rate for Payer: BCBS MAPPO |
$6,638.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,393.16
|
| Rate for Payer: BCN Commercial |
$2,393.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,638.30
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cofinity Commercial |
$2,901.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,469.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,638.30
|
| Rate for Payer: Healthscope Commercial |
$3,086.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,994.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,638.30
|
| Rate for Payer: Mclaren Commercial |
$2,778.08
|
| Rate for Payer: Mclaren Medicaid |
$3,631.15
|
| Rate for Payer: Mclaren Medicare |
$6,638.30
|
| Rate for Payer: Meridian Medicaid |
$3,813.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,970.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,634.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,623.74
|
| Rate for Payer: PACE Medicare |
$6,306.38
|
| Rate for Payer: PACE SWMI |
$6,638.30
|
| Rate for Payer: PHP Commercial |
$7,302.13
|
| Rate for Payer: PHP Medicaid |
$3,631.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,638.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,160.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,808.94
|
| Rate for Payer: Priority Health Medicare |
$6,638.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,191.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6,638.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,716.34
|
| Rate for Payer: UHC Medicare Advantage |
$6,837.45
|
| Rate for Payer: VA VA |
$6,638.30
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
IP
|
$3,086.75
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,160.72 |
| Max. Negotiated Rate |
$3,086.75 |
| Rate for Payer: Aetna Commercial |
$2,778.08
|
| Rate for Payer: ASR ASR |
$2,994.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,393.16
|
| Rate for Payer: BCN Commercial |
$2,393.16
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cofinity Commercial |
$2,901.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,469.40
|
| Rate for Payer: Healthscope Commercial |
$3,086.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,994.15
|
| Rate for Payer: Mclaren Commercial |
$2,778.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,623.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,160.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,716.34
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
OP
|
$2,978.40
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,084.88 |
| Max. Negotiated Rate |
$8,297.88 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Aetna Medicare |
$6,638.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,297.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,297.88
|
| Rate for Payer: ASR ASR |
$2,889.05
|
| Rate for Payer: BCBS Complete |
$3,813.04
|
| Rate for Payer: BCBS MAPPO |
$6,638.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.15
|
| Rate for Payer: BCN Commercial |
$2,309.15
|
| Rate for Payer: BCN Medicare Advantage |
$6,638.30
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cofinity Commercial |
$2,799.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,382.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,638.30
|
| Rate for Payer: Healthscope Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,638.30
|
| Rate for Payer: Mclaren Commercial |
$2,680.56
|
| Rate for Payer: Mclaren Medicaid |
$3,631.15
|
| Rate for Payer: Mclaren Medicare |
$6,638.30
|
| Rate for Payer: Meridian Medicaid |
$3,813.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,970.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,634.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,531.64
|
| Rate for Payer: PACE Medicare |
$6,306.38
|
| Rate for Payer: PACE SWMI |
$6,638.30
|
| Rate for Payer: PHP Commercial |
$7,302.13
|
| Rate for Payer: PHP Medicaid |
$3,631.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,638.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,084.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,710.34
|
| Rate for Payer: Priority Health Medicare |
$6,638.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,114.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6,638.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,620.99
|
| Rate for Payer: UHC Medicare Advantage |
$6,837.45
|
| Rate for Payer: VA VA |
$6,638.30
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
IP
|
$2,978.40
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,084.88 |
| Max. Negotiated Rate |
$2,978.40 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: ASR ASR |
$2,889.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.15
|
| Rate for Payer: BCN Commercial |
$2,309.15
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cofinity Commercial |
$2,799.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,382.72
|
| Rate for Payer: Healthscope Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.05
|
| Rate for Payer: Mclaren Commercial |
$2,680.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,531.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,084.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,620.99
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
OP
|
$5,403.31
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,161.32 |
| Max. Negotiated Rate |
$5,403.31 |
| Rate for Payer: Aetna Commercial |
$4,862.98
|
| Rate for Payer: ASR ASR |
$5,241.21
|
| Rate for Payer: BCBS Complete |
$2,161.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,189.19
|
| Rate for Payer: BCN Commercial |
$4,189.19
|
| Rate for Payer: Cash Price |
$4,322.65
|
| Rate for Payer: Cofinity Commercial |
$5,079.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.65
|
| Rate for Payer: Healthscope Commercial |
$5,403.31
|
| Rate for Payer: Healthscope Whirlpool |
$5,241.21
|
| Rate for Payer: Mclaren Commercial |
$4,862.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,592.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,917.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,836.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,754.91
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
IP
|
$5,403.31
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,782.32 |
| Max. Negotiated Rate |
$5,403.31 |
| Rate for Payer: Aetna Commercial |
$4,862.98
|
| Rate for Payer: ASR ASR |
$5,241.21
|
| Rate for Payer: BCBS Trust/PPO |
$4,189.19
|
| Rate for Payer: BCN Commercial |
$4,189.19
|
| Rate for Payer: Cash Price |
$4,322.65
|
| Rate for Payer: Cofinity Commercial |
$5,079.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.65
|
| Rate for Payer: Healthscope Commercial |
$5,403.31
|
| Rate for Payer: Healthscope Whirlpool |
$5,241.21
|
| Rate for Payer: Mclaren Commercial |
$4,862.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,592.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,754.91
|
|
|
HC INTRACAV APPL - I
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$560.70 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Commercial |
$505.82
|
| Rate for Payer: ASR ASR |
$545.16
|
| Rate for Payer: ASR ASR |
$776.97
|
| Rate for Payer: BCBS Trust/PPO |
$435.73
|
| Rate for Payer: BCBS Trust/PPO |
$621.02
|
| Rate for Payer: BCN Commercial |
$435.73
|
| Rate for Payer: BCN Commercial |
$621.02
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cofinity Commercial |
$528.30
|
| Rate for Payer: Cofinity Commercial |
$752.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.62
|
| Rate for Payer: Healthscope Commercial |
$562.02
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Healthscope Whirlpool |
$776.97
|
| Rate for Payer: Healthscope Whirlpool |
$545.16
|
| Rate for Payer: Mclaren Commercial |
$720.90
|
| Rate for Payer: Mclaren Commercial |
$505.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.88
|
|
|
HC INTRACAV APPL - I
|
Facility
|
OP
|
$562.02
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$654.06 |
| Rate for Payer: Aetna Commercial |
$505.82
|
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: ASR ASR |
$776.97
|
| Rate for Payer: ASR ASR |
$545.16
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS Trust/PPO |
$435.73
|
| Rate for Payer: BCBS Trust/PPO |
$621.02
|
| Rate for Payer: BCN Commercial |
$435.73
|
| Rate for Payer: BCN Commercial |
$621.02
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cofinity Commercial |
$528.30
|
| Rate for Payer: Cofinity Commercial |
$752.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Healthscope Commercial |
$562.02
|
| Rate for Payer: Healthscope Whirlpool |
$545.16
|
| Rate for Payer: Healthscope Whirlpool |
$776.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Mclaren Commercial |
$505.82
|
| Rate for Payer: Mclaren Commercial |
$720.90
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.85
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.44
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Narrow Network |
$399.03
|
| Rate for Payer: Priority Health Narrow Network |
$568.71
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.88
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: VA VA |
$523.25
|
| Rate for Payer: VA VA |
$523.25
|
|
