|
HC DPPX AB CBA, S
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: ASR Commercial |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$207.80
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC DPPX AB IFA, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC DPPX AB IFA, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC DRAINAGE ABSC CST HEMAT DENTOALVEOLAR STRUX
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.15 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: ASR ASR |
$359.87
|
| Rate for Payer: ASR Commercial |
$359.87
|
| Rate for Payer: BCBS Trust/PPO |
$302.33
|
| Rate for Payer: BCN Commercial |
$287.64
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.80
|
| Rate for Payer: Healthscope Commercial |
$371.00
|
| Rate for Payer: Healthscope Whirlpool |
$359.87
|
| Rate for Payer: Mclaren Commercial |
$333.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.35
|
| Rate for Payer: Nomi Health Commercial |
$304.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.48
|
|
|
HC DRAINAGE ABSC CST HEMAT DENTOALVEOLAR STRUX
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$359.87
|
| Rate for Payer: ASR Commercial |
$359.87
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$303.81
|
| Rate for Payer: BCN Commercial |
$287.64
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$371.00
|
| Rate for Payer: Healthscope Whirlpool |
$359.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$333.90
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.35
|
| Rate for Payer: Nomi Health Commercial |
$304.22
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.07
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$260.07
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
|
HC DRAINAGE CATHETER LVL 15
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$1,590.00 |
| Rate for Payer: Aetna Commercial |
$1,431.00
|
| Rate for Payer: Aetna Medicare |
$795.00
|
| Rate for Payer: ASR ASR |
$1,542.30
|
| Rate for Payer: ASR Commercial |
$1,542.30
|
| Rate for Payer: BCBS Complete |
$636.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.05
|
| Rate for Payer: BCN Commercial |
$1,232.73
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,494.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.00
|
| Rate for Payer: Healthscope Commercial |
$1,590.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,542.30
|
| Rate for Payer: Mclaren Commercial |
$1,431.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.50
|
| Rate for Payer: Nomi Health Commercial |
$1,303.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,393.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,114.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,399.20
|
|
|
HC DRAINAGE CATHETER LVL 15
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.50 |
| Max. Negotiated Rate |
$1,590.00 |
| Rate for Payer: Aetna Commercial |
$1,431.00
|
| Rate for Payer: ASR ASR |
$1,542.30
|
| Rate for Payer: ASR Commercial |
$1,542.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.69
|
| Rate for Payer: BCN Commercial |
$1,232.73
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,494.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.00
|
| Rate for Payer: Healthscope Commercial |
$1,590.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,542.30
|
| Rate for Payer: Mclaren Commercial |
$1,431.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.50
|
| Rate for Payer: Nomi Health Commercial |
$1,303.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,399.20
|
|
|
HC DRAINAGE CATHETER LVL 2
|
Facility
|
OP
|
$232.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.02 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: Aetna Medicare |
$116.28
|
| Rate for Payer: ASR ASR |
$225.58
|
| Rate for Payer: ASR Commercial |
$225.58
|
| Rate for Payer: BCBS Complete |
$93.02
|
| Rate for Payer: BCBS Trust/PPO |
$190.44
|
| Rate for Payer: BCN Commercial |
$180.30
|
| Rate for Payer: Cash Price |
$186.05
|
| Rate for Payer: Cofinity Commercial |
$218.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.05
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Healthscope Whirlpool |
$225.58
|
| Rate for Payer: Mclaren Commercial |
$209.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.68
|
| Rate for Payer: Nomi Health Commercial |
$190.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.77
|
| Rate for Payer: Priority Health Narrow Network |
$163.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.65
|
|
|
HC DRAINAGE CATHETER LVL 2
|
Facility
|
IP
|
$232.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: ASR ASR |
$225.58
|
| Rate for Payer: ASR Commercial |
$225.58
|
| Rate for Payer: BCBS Trust/PPO |
$189.51
|
| Rate for Payer: BCN Commercial |
$180.30
|
| Rate for Payer: Cash Price |
$186.05
|
| Rate for Payer: Cofinity Commercial |
$218.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.05
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Healthscope Whirlpool |
$225.58
|
| Rate for Payer: Mclaren Commercial |
$209.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.68
|
| Rate for Payer: Nomi Health Commercial |
$190.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.65
|
|
|
HC DRAINAGE CATHETER LVL 3
|
Facility
|
IP
|
$385.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.61 |
| Max. Negotiated Rate |
$385.56 |
| Rate for Payer: Aetna Commercial |
$347.00
|
| Rate for Payer: ASR ASR |
$373.99
|
| Rate for Payer: ASR Commercial |
$373.99
|
| Rate for Payer: BCBS Trust/PPO |
$314.19
|
| Rate for Payer: BCN Commercial |
$298.92
|
| Rate for Payer: Cash Price |
$308.45
|
| Rate for Payer: Cofinity Commercial |
$362.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.45
|
| Rate for Payer: Healthscope Commercial |
$385.56
|
| Rate for Payer: Healthscope Whirlpool |
$373.99
|
| Rate for Payer: Mclaren Commercial |
$347.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.73
|
| Rate for Payer: Nomi Health Commercial |
$316.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.29
|
|
|
HC DRAINAGE CATHETER LVL 3
|
Facility
|
OP
|
$385.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$385.56 |
| Rate for Payer: Aetna Commercial |
$347.00
|
| Rate for Payer: Aetna Medicare |
$192.78
|
| Rate for Payer: ASR ASR |
$373.99
|
| Rate for Payer: ASR Commercial |
$373.99
|
| Rate for Payer: BCBS Complete |
$154.22
|
| Rate for Payer: BCBS Trust/PPO |
$315.74
|
| Rate for Payer: BCN Commercial |
$298.92
|
| Rate for Payer: Cash Price |
$308.45
|
| Rate for Payer: Cofinity Commercial |
$362.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.45
|
| Rate for Payer: Healthscope Commercial |
$385.56
|
| Rate for Payer: Healthscope Whirlpool |
$373.99
|
| Rate for Payer: Mclaren Commercial |
$347.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.73
|
| Rate for Payer: Nomi Health Commercial |
$316.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.83
|
| Rate for Payer: Priority Health Narrow Network |
$270.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.29
|
|
|
HC DRAINAGE CATHETER LVL 4
|
Facility
|
OP
|
$538.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.42 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$484.70
|
| Rate for Payer: Aetna Medicare |
$269.28
|
| Rate for Payer: ASR ASR |
$522.40
|
| Rate for Payer: ASR Commercial |
$522.40
|
| Rate for Payer: BCBS Complete |
$215.42
|
| Rate for Payer: BCBS Trust/PPO |
$441.03
|
| Rate for Payer: BCN Commercial |
$417.55
|
| Rate for Payer: Cash Price |
$430.85
|
| Rate for Payer: Cofinity Commercial |
$506.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.85
|
| Rate for Payer: Healthscope Commercial |
$538.56
|
| Rate for Payer: Healthscope Whirlpool |
$522.40
|
| Rate for Payer: Mclaren Commercial |
$484.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.78
|
| Rate for Payer: Nomi Health Commercial |
$441.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.89
|
| Rate for Payer: Priority Health Narrow Network |
$377.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.93
|
|
|
HC DRAINAGE CATHETER LVL 4
|
Facility
|
IP
|
$538.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.06 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$484.70
|
| Rate for Payer: ASR ASR |
$522.40
|
| Rate for Payer: ASR Commercial |
$522.40
|
| Rate for Payer: BCBS Trust/PPO |
$438.87
|
| Rate for Payer: BCN Commercial |
$417.55
|
| Rate for Payer: Cash Price |
$430.85
|
| Rate for Payer: Cofinity Commercial |
$506.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.85
|
| Rate for Payer: Healthscope Commercial |
$538.56
|
| Rate for Payer: Healthscope Whirlpool |
$522.40
|
| Rate for Payer: Mclaren Commercial |
$484.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.78
|
| Rate for Payer: Nomi Health Commercial |
$441.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.93
|
|
|
HC DRAINAGE CATHETER LVL 9
|
Facility
|
IP
|
$919.13
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.43 |
| Max. Negotiated Rate |
$919.13 |
| Rate for Payer: Aetna Commercial |
$827.22
|
| Rate for Payer: ASR ASR |
$891.56
|
| Rate for Payer: ASR Commercial |
$891.56
|
| Rate for Payer: BCBS Trust/PPO |
$749.00
|
| Rate for Payer: BCN Commercial |
$712.60
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cofinity Commercial |
$863.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.30
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Healthscope Whirlpool |
$891.56
|
| Rate for Payer: Mclaren Commercial |
$827.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.26
|
| Rate for Payer: Nomi Health Commercial |
$753.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.83
|
|
|
HC DRAINAGE CATHETER LVL 9
|
Facility
|
OP
|
$919.13
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.65 |
| Max. Negotiated Rate |
$919.13 |
| Rate for Payer: Aetna Commercial |
$827.22
|
| Rate for Payer: Aetna Medicare |
$459.56
|
| Rate for Payer: ASR ASR |
$891.56
|
| Rate for Payer: ASR Commercial |
$891.56
|
| Rate for Payer: BCBS Complete |
$367.65
|
| Rate for Payer: BCBS Trust/PPO |
$752.68
|
| Rate for Payer: BCN Commercial |
$712.60
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cofinity Commercial |
$863.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.30
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Healthscope Whirlpool |
$891.56
|
| Rate for Payer: Mclaren Commercial |
$827.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.26
|
| Rate for Payer: Nomi Health Commercial |
$753.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.34
|
| Rate for Payer: Priority Health Narrow Network |
$644.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.83
|
|
|
HC DRAINAGE FINGER ABSCESS COMPLICATED
|
Facility
|
OP
|
$4,282.71
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,282.71 |
| Rate for Payer: Aetna Commercial |
$3,854.44
|
| 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 |
$4,154.23
|
| Rate for Payer: ASR Commercial |
$4,154.23
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,507.11
|
| Rate for Payer: BCN Commercial |
$3,320.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$3,426.17
|
| Rate for Payer: Cash Price |
$3,426.17
|
| Rate for Payer: Cofinity Commercial |
$4,025.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,426.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$4,282.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,154.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$3,854.44
|
| 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 |
$3,640.30
|
| Rate for Payer: Nomi Health Commercial |
$3,511.82
|
| 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 |
$2,783.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,752.51
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,002.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,768.78
|
| 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 DRAINAGE FINGER ABSCESS COMPLICATED
|
Facility
|
IP
|
$4,282.71
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,783.76 |
| Max. Negotiated Rate |
$4,282.71 |
| Rate for Payer: Aetna Commercial |
$3,854.44
|
| Rate for Payer: ASR ASR |
$4,154.23
|
| Rate for Payer: ASR Commercial |
$4,154.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,489.98
|
| Rate for Payer: BCN Commercial |
$3,320.39
|
| Rate for Payer: Cash Price |
$3,426.17
|
| Rate for Payer: Cofinity Commercial |
$4,025.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,426.17
|
| Rate for Payer: Healthscope Commercial |
$4,282.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,154.23
|
| Rate for Payer: Mclaren Commercial |
$3,854.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,640.30
|
| Rate for Payer: Nomi Health Commercial |
$3,511.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,783.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,768.78
|
|
|
HC DRAINAGE OF FINGER ABSCESS
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: ASR Commercial |
$504.59
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$425.99
|
| Rate for Payer: BCN Commercial |
$403.31
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$520.20
|
| Rate for Payer: Healthscope Whirlpool |
$504.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.80
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$364.66
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DRAINAGE OF FINGER ABSCESS
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: ASR Commercial |
$504.59
|
| Rate for Payer: BCBS Trust/PPO |
$423.91
|
| Rate for Payer: BCN Commercial |
$403.31
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$520.20
|
| Rate for Payer: Healthscope Whirlpool |
$504.59
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
|
|
HC DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Facility
|
IP
|
$2,094.48
|
|
|
Service Code
|
CPT 58822
|
| Hospital Charge Code |
36100259
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,361.41 |
| Max. Negotiated Rate |
$2,094.48 |
| Rate for Payer: Aetna Commercial |
$1,885.03
|
| Rate for Payer: ASR ASR |
$2,031.65
|
| Rate for Payer: ASR Commercial |
$2,031.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,706.79
|
| Rate for Payer: BCN Commercial |
$1,623.85
|
| Rate for Payer: Cash Price |
$1,675.58
|
| Rate for Payer: Cofinity Commercial |
$1,968.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,675.58
|
| Rate for Payer: Healthscope Commercial |
$2,094.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,031.65
|
| Rate for Payer: Mclaren Commercial |
$1,885.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,780.31
|
| Rate for Payer: Nomi Health Commercial |
$1,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,843.14
|
|
|
HC DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Facility
|
OP
|
$2,094.48
|
|
|
Service Code
|
CPT 58822
|
| Hospital Charge Code |
36100259
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$837.79 |
| Max. Negotiated Rate |
$2,094.48 |
| Rate for Payer: Aetna Commercial |
$1,885.03
|
| Rate for Payer: Aetna Medicare |
$1,047.24
|
| Rate for Payer: ASR ASR |
$2,031.65
|
| Rate for Payer: ASR Commercial |
$2,031.65
|
| Rate for Payer: BCBS Complete |
$837.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,715.17
|
| Rate for Payer: BCN Commercial |
$1,623.85
|
| Rate for Payer: Cash Price |
$1,675.58
|
| Rate for Payer: Cofinity Commercial |
$1,968.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,675.58
|
| Rate for Payer: Healthscope Commercial |
$2,094.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,031.65
|
| Rate for Payer: Mclaren Commercial |
$1,885.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,780.31
|
| Rate for Payer: Nomi Health Commercial |
$1,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,835.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,468.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,843.14
|
|
