|
HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
OP
|
$4,031.01
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$3,627.91
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$3,910.08
|
| Rate for Payer: ASR Commercial |
$3,910.08
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,300.99
|
| Rate for Payer: BCN Commercial |
$3,125.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cofinity Commercial |
$3,789.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,224.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$4,031.01
|
| Rate for Payer: Healthscope Whirlpool |
$3,910.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$3,627.91
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,426.36
|
| Rate for Payer: Nomi Health Commercial |
$3,305.43
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,620.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,531.97
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,825.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,547.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$7,960.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,960.00 |
| Rate for Payer: Aetna Commercial |
$7,164.00
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$7,721.20
|
| Rate for Payer: ASR Commercial |
$7,721.20
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,518.44
|
| Rate for Payer: BCN Commercial |
$6,171.39
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cofinity Commercial |
$7,482.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,368.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$7,960.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,721.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$7,164.00
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,766.00
|
| Rate for Payer: Nomi Health Commercial |
$6,527.20
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,174.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,974.55
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$5,579.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,004.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$7,960.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,174.00 |
| Max. Negotiated Rate |
$7,960.00 |
| Rate for Payer: Aetna Commercial |
$7,164.00
|
| Rate for Payer: ASR ASR |
$7,721.20
|
| Rate for Payer: ASR Commercial |
$7,721.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,486.60
|
| Rate for Payer: BCN Commercial |
$6,171.39
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cofinity Commercial |
$7,482.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,368.00
|
| Rate for Payer: Healthscope Commercial |
$7,960.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,721.20
|
| Rate for Payer: Mclaren Commercial |
$7,164.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,766.00
|
| Rate for Payer: Nomi Health Commercial |
$6,527.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,174.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,004.80
|
|
|
HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$2,927.69
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,927.69 |
| Rate for Payer: Aetna Commercial |
$2,634.92
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,839.86
|
| Rate for Payer: ASR Commercial |
$2,839.86
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,397.49
|
| Rate for Payer: BCN Commercial |
$2,269.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,752.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,927.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,839.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,634.92
|
| 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 |
$2,488.54
|
| Rate for Payer: Nomi Health Commercial |
$2,400.71
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,565.24
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,052.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,576.37
|
| 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 EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
IP
|
$2,927.69
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,903.00 |
| Max. Negotiated Rate |
$2,927.69 |
| Rate for Payer: Aetna Commercial |
$2,634.92
|
| Rate for Payer: ASR ASR |
$2,839.86
|
| Rate for Payer: ASR Commercial |
$2,839.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,385.77
|
| Rate for Payer: BCN Commercial |
$2,269.84
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,752.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Healthscope Commercial |
$2,927.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,839.86
|
| Rate for Payer: Mclaren Commercial |
$2,634.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,488.54
|
| Rate for Payer: Nomi Health Commercial |
$2,400.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,576.37
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
OP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$408.10 |
| Max. Negotiated Rate |
$1,020.24 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: Aetna Medicare |
$510.12
|
| Rate for Payer: ASR ASR |
$989.63
|
| Rate for Payer: ASR Commercial |
$989.63
|
| Rate for Payer: BCBS Complete |
$408.10
|
| Rate for Payer: BCBS Trust/PPO |
$835.47
|
| Rate for Payer: BCN Commercial |
$790.99
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$959.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Healthscope Commercial |
$1,020.24
|
| Rate for Payer: Healthscope Whirlpool |
$989.63
|
| Rate for Payer: Mclaren Commercial |
$918.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: Nomi Health Commercial |
$836.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.93
|
| Rate for Payer: Priority Health Narrow Network |
$715.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.81
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
IP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.16 |
| Max. Negotiated Rate |
$1,020.24 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: ASR ASR |
$989.63
|
| Rate for Payer: ASR Commercial |
$989.63
|
| Rate for Payer: BCBS Trust/PPO |
$831.39
|
| Rate for Payer: BCN Commercial |
$790.99
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$959.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Healthscope Commercial |
$1,020.24
|
| Rate for Payer: Healthscope Whirlpool |
$989.63
|
| Rate for Payer: Mclaren Commercial |
$918.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: Nomi Health Commercial |
$836.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.81
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
OP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna Commercial |
$310.23
|
| 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 |
$334.36
|
| Rate for Payer: ASR Commercial |
$334.36
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$282.27
|
| Rate for Payer: BCN Commercial |
$267.25
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$324.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Healthscope Whirlpool |
$334.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$310.23
|
| 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 |
$293.00
|
| Rate for Payer: Nomi Health Commercial |
$282.65
|
| 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 |
$224.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.03
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$241.63
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.34
|
| 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 EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
IP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$224.06 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna Commercial |
$310.23
|
| Rate for Payer: ASR ASR |
$334.36
|
| Rate for Payer: ASR Commercial |
$334.36
|
| Rate for Payer: BCBS Trust/PPO |
$280.90
|
| Rate for Payer: BCN Commercial |
$267.25
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$324.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Healthscope Whirlpool |
$334.36
|
| Rate for Payer: Mclaren Commercial |
$310.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.00
|
| Rate for Payer: Nomi Health Commercial |
$282.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.34
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
OP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$136.25 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$132.16
|
| Rate for Payer: ASR Commercial |
$132.16
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$111.58
|
| Rate for Payer: BCN Commercial |
$105.63
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$136.25
|
| Rate for Payer: Healthscope Whirlpool |
$132.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$122.62
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: Nomi Health Commercial |
$111.72
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.38
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$95.51
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
IP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$136.25 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: ASR ASR |
$132.16
|
| Rate for Payer: ASR Commercial |
$132.16
|
| Rate for Payer: BCBS Trust/PPO |
$111.03
|
| Rate for Payer: BCN Commercial |
$105.63
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Healthscope Commercial |
$136.25
|
| Rate for Payer: Healthscope Whirlpool |
$132.16
|
| Rate for Payer: Mclaren Commercial |
$122.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: Nomi Health Commercial |
$111.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.90
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,748.11
|
| 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 |
$1,884.07
|
| Rate for Payer: ASR Commercial |
$1,884.07
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,590.58
|
| Rate for Payer: BCN Commercial |
$1,505.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,825.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,942.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,748.11
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: Nomi Health Commercial |
$1,592.72
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.88
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,361.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.26
|
| 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 EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,262.52 |
| Max. Negotiated Rate |
$1,942.34 |
| Rate for Payer: Aetna Commercial |
$1,748.11
|
| Rate for Payer: ASR ASR |
$1,884.07
|
| Rate for Payer: ASR Commercial |
$1,884.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.81
|
| Rate for Payer: BCN Commercial |
$1,505.90
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,825.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Healthscope Commercial |
$1,942.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.07
|
| Rate for Payer: Mclaren Commercial |
$1,748.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: Nomi Health Commercial |
$1,592.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.26
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$704.37 |
| Max. Negotiated Rate |
$1,760.92 |
| Rate for Payer: Aetna Commercial |
$1,584.83
|
| Rate for Payer: Aetna Medicare |
$880.46
|
| Rate for Payer: ASR ASR |
$1,708.09
|
| Rate for Payer: ASR Commercial |
$1,708.09
|
| Rate for Payer: BCBS Complete |
$704.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,442.02
|
| Rate for Payer: BCN Commercial |
$1,365.24
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,655.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Healthscope Commercial |
$1,760.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,708.09
|
| Rate for Payer: Mclaren Commercial |
$1,584.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: Nomi Health Commercial |
$1,443.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,549.61
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,144.60 |
| Max. Negotiated Rate |
$1,760.92 |
| Rate for Payer: Aetna Commercial |
$1,584.83
|
| Rate for Payer: ASR ASR |
$1,708.09
|
| Rate for Payer: ASR Commercial |
$1,708.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.97
|
| Rate for Payer: BCN Commercial |
$1,365.24
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,655.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Healthscope Commercial |
$1,760.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,708.09
|
| Rate for Payer: Mclaren Commercial |
$1,584.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: Nomi Health Commercial |
$1,443.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,549.61
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$823.52 |
| Max. Negotiated Rate |
$2,058.81 |
| Rate for Payer: Aetna Commercial |
$1,852.93
|
| Rate for Payer: Aetna Medicare |
$1,029.40
|
| Rate for Payer: ASR ASR |
$1,997.05
|
| Rate for Payer: ASR Commercial |
$1,997.05
|
| Rate for Payer: BCBS Complete |
$823.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.96
|
| Rate for Payer: BCN Commercial |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$2,058.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.05
|
| Rate for Payer: Mclaren Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,443.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,811.75
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,338.23 |
| Max. Negotiated Rate |
$2,058.81 |
| Rate for Payer: Aetna Commercial |
$1,852.93
|
| Rate for Payer: ASR ASR |
$1,997.05
|
| Rate for Payer: ASR Commercial |
$1,997.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.72
|
| Rate for Payer: BCN Commercial |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$2,058.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.05
|
| Rate for Payer: Mclaren Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,811.75
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$900.11 |
| Max. Negotiated Rate |
$2,250.28 |
| Rate for Payer: Aetna Commercial |
$2,025.25
|
| Rate for Payer: Aetna Medicare |
$1,125.14
|
| Rate for Payer: ASR ASR |
$2,182.77
|
| Rate for Payer: ASR Commercial |
$2,182.77
|
| Rate for Payer: BCBS Complete |
$900.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,842.75
|
| Rate for Payer: BCN Commercial |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$2,115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,250.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.77
|
| Rate for Payer: Mclaren Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,971.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,577.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.25
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,462.68 |
| Max. Negotiated Rate |
$2,250.28 |
| Rate for Payer: Aetna Commercial |
$2,025.25
|
| Rate for Payer: ASR ASR |
$2,182.77
|
| Rate for Payer: ASR Commercial |
$2,182.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,833.75
|
| Rate for Payer: BCN Commercial |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$2,115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,250.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.77
|
| Rate for Payer: Mclaren Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.25
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,251.77 |
| Max. Negotiated Rate |
$1,925.80 |
| Rate for Payer: Aetna Commercial |
$1,733.22
|
| Rate for Payer: ASR ASR |
$1,868.03
|
| Rate for Payer: ASR Commercial |
$1,868.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.33
|
| Rate for Payer: BCN Commercial |
$1,493.07
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,925.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.03
|
| Rate for Payer: Mclaren Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.70
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$770.32 |
| Max. Negotiated Rate |
$1,925.80 |
| Rate for Payer: Aetna Commercial |
$1,733.22
|
| Rate for Payer: Aetna Medicare |
$962.90
|
| Rate for Payer: ASR ASR |
$1,868.03
|
| Rate for Payer: ASR Commercial |
$1,868.03
|
| Rate for Payer: BCBS Complete |
$770.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.04
|
| Rate for Payer: BCN Commercial |
$1,493.07
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,925.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.03
|
| Rate for Payer: Mclaren Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,687.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.70
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.79 |
| Max. Negotiated Rate |
$2,031.98 |
| Rate for Payer: Aetna Commercial |
$1,828.78
|
| Rate for Payer: Aetna Medicare |
$1,015.99
|
| Rate for Payer: ASR ASR |
$1,971.02
|
| Rate for Payer: ASR Commercial |
$1,971.02
|
| Rate for Payer: BCBS Complete |
$812.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.99
|
| Rate for Payer: BCN Commercial |
$1,575.39
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,910.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$2,031.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.02
|
| Rate for Payer: Mclaren Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,780.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.14
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.79 |
| Max. Negotiated Rate |
$2,031.98 |
| Rate for Payer: Aetna Commercial |
$1,828.78
|
| Rate for Payer: ASR ASR |
$1,971.02
|
| Rate for Payer: ASR Commercial |
$1,971.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.86
|
| Rate for Payer: BCN Commercial |
$1,575.39
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,910.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$2,031.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.02
|
| Rate for Payer: Mclaren Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.14
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.26 |
| Max. Negotiated Rate |
$2,370.66 |
| Rate for Payer: Aetna Commercial |
$2,133.59
|
| Rate for Payer: Aetna Medicare |
$1,185.33
|
| Rate for Payer: ASR ASR |
$2,299.54
|
| Rate for Payer: ASR Commercial |
$2,299.54
|
| Rate for Payer: BCBS Complete |
$948.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,941.33
|
| Rate for Payer: BCN Commercial |
$1,837.97
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,228.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.54
|
| Rate for Payer: Mclaren Commercial |
$2,133.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,077.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,661.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,086.18
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.93 |
| Max. Negotiated Rate |
$2,370.66 |
| Rate for Payer: Aetna Commercial |
$2,133.59
|
| Rate for Payer: ASR ASR |
$2,299.54
|
| Rate for Payer: ASR Commercial |
$2,299.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.85
|
| Rate for Payer: BCN Commercial |
$1,837.97
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,228.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.54
|
| Rate for Payer: Mclaren Commercial |
$2,133.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,086.18
|
|
