|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
OP
|
$1,068.55
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,068.55 |
| Rate for Payer: Aetna Commercial |
$961.70
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$1,036.49
|
| Rate for Payer: ASR Commercial |
$1,036.49
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$875.04
|
| Rate for Payer: BCN Commercial |
$828.45
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$854.84
|
| Rate for Payer: Cash Price |
$854.84
|
| Rate for Payer: Cofinity Commercial |
$1,004.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,068.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,036.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$961.70
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.27
|
| Rate for Payer: Nomi Health Commercial |
$876.21
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.26
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$749.05
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
IP
|
$150.86
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$150.86 |
| Rate for Payer: Aetna Commercial |
$135.77
|
| Rate for Payer: ASR ASR |
$146.33
|
| Rate for Payer: ASR Commercial |
$146.33
|
| Rate for Payer: BCBS Trust/PPO |
$122.94
|
| Rate for Payer: BCN Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$120.69
|
| Rate for Payer: Cofinity Commercial |
$141.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$150.86
|
| Rate for Payer: Healthscope Whirlpool |
$146.33
|
| Rate for Payer: Mclaren Commercial |
$135.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.23
|
| Rate for Payer: Nomi Health Commercial |
$123.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.76
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
OP
|
$150.86
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.34 |
| Max. Negotiated Rate |
$150.86 |
| Rate for Payer: Aetna Commercial |
$135.77
|
| Rate for Payer: Aetna Medicare |
$75.43
|
| Rate for Payer: ASR ASR |
$146.33
|
| Rate for Payer: ASR Commercial |
$146.33
|
| Rate for Payer: BCBS Complete |
$60.34
|
| Rate for Payer: BCBS Trust/PPO |
$123.54
|
| Rate for Payer: BCN Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$120.69
|
| Rate for Payer: Cofinity Commercial |
$141.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$150.86
|
| Rate for Payer: Healthscope Whirlpool |
$146.33
|
| Rate for Payer: Mclaren Commercial |
$135.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.23
|
| Rate for Payer: Nomi Health Commercial |
$123.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.18
|
| Rate for Payer: Priority Health Narrow Network |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.76
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
IP
|
$165.94
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$165.94 |
| Rate for Payer: Aetna Commercial |
$149.35
|
| Rate for Payer: ASR ASR |
$160.96
|
| Rate for Payer: ASR Commercial |
$160.96
|
| Rate for Payer: BCBS Trust/PPO |
$135.22
|
| Rate for Payer: BCN Commercial |
$128.65
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cofinity Commercial |
$155.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.75
|
| Rate for Payer: Healthscope Commercial |
$165.94
|
| Rate for Payer: Healthscope Whirlpool |
$160.96
|
| Rate for Payer: Mclaren Commercial |
$149.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: Nomi Health Commercial |
$136.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.03
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$165.94
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.38 |
| Max. Negotiated Rate |
$165.94 |
| Rate for Payer: Aetna Commercial |
$149.35
|
| Rate for Payer: Aetna Medicare |
$82.97
|
| Rate for Payer: ASR ASR |
$160.96
|
| Rate for Payer: ASR Commercial |
$160.96
|
| Rate for Payer: BCBS Complete |
$66.38
|
| Rate for Payer: BCBS Trust/PPO |
$135.89
|
| Rate for Payer: BCN Commercial |
$128.65
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cofinity Commercial |
$155.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.75
|
| Rate for Payer: Healthscope Commercial |
$165.94
|
| Rate for Payer: Healthscope Whirlpool |
$160.96
|
| Rate for Payer: Mclaren Commercial |
$149.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: Nomi Health Commercial |
$136.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.40
|
| Rate for Payer: Priority Health Narrow Network |
$116.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.03
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.59 |
| Max. Negotiated Rate |
$214.75 |
| Rate for Payer: Aetna Commercial |
$193.28
|
| Rate for Payer: ASR ASR |
$208.31
|
| Rate for Payer: ASR Commercial |
$208.31
|
| Rate for Payer: BCBS Trust/PPO |
$175.00
|
| Rate for Payer: BCN Commercial |
$166.50
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Healthscope Commercial |
$214.75
|
| Rate for Payer: Healthscope Whirlpool |
$208.31
|
| Rate for Payer: Mclaren Commercial |
$193.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: Nomi Health Commercial |
$176.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.98
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.90 |
| Max. Negotiated Rate |
$214.75 |
| Rate for Payer: Aetna Commercial |
$193.28
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: ASR ASR |
$208.31
|
| Rate for Payer: ASR Commercial |
$208.31
|
| Rate for Payer: BCBS Complete |
$85.90
|
| Rate for Payer: BCBS Trust/PPO |
$175.86
|
| Rate for Payer: BCN Commercial |
$166.50
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Healthscope Commercial |
$214.75
|
| Rate for Payer: Healthscope Whirlpool |
$208.31
|
| Rate for Payer: Mclaren Commercial |
$193.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: Nomi Health Commercial |
$176.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.16
|
| Rate for Payer: Priority Health Narrow Network |
$150.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.98
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
OP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,138.32 |
| Rate for Payer: Aetna Commercial |
$1,024.49
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$1,104.17
|
| Rate for Payer: ASR Commercial |
$1,104.17
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$932.17
|
| Rate for Payer: BCN Commercial |
$882.54
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$1,070.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$1,138.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$1,024.49
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: Nomi Health Commercial |
$933.42
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$997.40
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$797.96
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
IP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.91 |
| Max. Negotiated Rate |
$1,138.32 |
| Rate for Payer: Aetna Commercial |
$1,024.49
|
| Rate for Payer: ASR ASR |
$1,104.17
|
| Rate for Payer: ASR Commercial |
$1,104.17
|
| Rate for Payer: BCBS Trust/PPO |
$927.62
|
| Rate for Payer: BCN Commercial |
$882.54
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$1,070.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Healthscope Commercial |
$1,138.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.17
|
| Rate for Payer: Mclaren Commercial |
$1,024.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: Nomi Health Commercial |
$933.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.72
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: ASR ASR |
$72.46
|
| Rate for Payer: ASR Commercial |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$60.87
|
| Rate for Payer: BCN Commercial |
$57.91
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Healthscope Whirlpool |
$72.46
|
| Rate for Payer: Mclaren Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.74
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$259.04 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Aetna Medicare |
$167.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: ASR ASR |
$72.46
|
| Rate for Payer: ASR Commercial |
$72.46
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCBS Trust/PPO |
$61.17
|
| Rate for Payer: BCN Commercial |
$57.91
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Healthscope Whirlpool |
$72.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.12
|
| Rate for Payer: Mclaren Commercial |
$67.23
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$183.83
|
| Rate for Payer: PHP Medicaid |
$89.58
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.45
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health Narrow Network |
$52.36
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$259.04
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP DNSP |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$89.58
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health Narrow Network |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna Commercial |
$199.62
|
| Rate for Payer: Aetna Medicare |
$52.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.14
|
| Rate for Payer: ASR ASR |
$215.15
|
| Rate for Payer: ASR Commercial |
$215.15
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$181.63
|
| Rate for Payer: BCN Commercial |
$171.96
|
| Rate for Payer: BCN Medicare Advantage |
$52.11
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$208.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$221.80
|
| Rate for Payer: Healthscope Whirlpool |
$215.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.11
|
| Rate for Payer: Mclaren Commercial |
$199.62
|
| Rate for Payer: Mclaren Medicaid |
$27.93
|
| Rate for Payer: Mclaren Medicare |
$52.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.72
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: Nomi Health Commercial |
$181.88
|
| Rate for Payer: PACE Medicare |
$49.50
|
| Rate for Payer: PACE SWMI |
$52.11
|
| Rate for Payer: PHP Commercial |
$57.32
|
| Rate for Payer: PHP Medicaid |
$27.93
|
| Rate for Payer: PHP Medicare Advantage |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.34
|
| Rate for Payer: Priority Health Medicare |
$52.11
|
| Rate for Payer: Priority Health Narrow Network |
$155.48
|
| Rate for Payer: Railroad Medicare Medicare |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.11
|
| Rate for Payer: UHC Exchange |
$80.77
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
| Rate for Payer: UHCCP DNSP |
$52.11
|
| Rate for Payer: UHCCP Medicaid |
$27.93
|
| Rate for Payer: VA VA |
$52.11
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna Commercial |
$199.62
|
| Rate for Payer: ASR ASR |
$215.15
|
| Rate for Payer: ASR Commercial |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.74
|
| Rate for Payer: BCN Commercial |
$171.96
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$208.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Healthscope Commercial |
$221.80
|
| Rate for Payer: Healthscope Whirlpool |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$199.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: Nomi Health Commercial |
$181.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.18
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.38
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.70
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.44
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.70
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Medicaid |
$7.88
|
| Rate for Payer: PHP Medicare Advantage |
$14.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.70
|
| Rate for Payer: UHC Exchange |
$22.79
|
| Rate for Payer: UHC Medicare Advantage |
$14.70
|
| Rate for Payer: UHCCP DNSP |
$14.70
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
| Rate for Payer: VA VA |
$14.70
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.21 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Trust/PPO |
$407.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.13 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: Aetna Medicare |
$250.16
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Complete |
$200.13
|
| Rate for Payer: BCBS Trust/PPO |
$409.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.38
|
| Rate for Payer: Priority Health Narrow Network |
$350.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$58.99
|
| Rate for Payer: Aetna Medicare |
$18.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.23
|
| Rate for Payer: ASR ASR |
$63.58
|
| Rate for Payer: ASR Commercial |
$63.58
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS MAPPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$53.68
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$61.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.58
|
| Rate for Payer: Mclaren Commercial |
$58.99
|
| Rate for Payer: Mclaren Medicaid |
$9.96
|
| Rate for Payer: Mclaren Medicare |
$18.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: Meridian Medicaid |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PACE Medicare |
$17.65
|
| Rate for Payer: PACE SWMI |
$18.58
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Medicaid |
$9.96
|
| Rate for Payer: PHP Medicare Advantage |
$18.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.43
|
| Rate for Payer: Priority Health Medicare |
$18.58
|
| Rate for Payer: Priority Health Narrow Network |
$45.95
|
| Rate for Payer: Railroad Medicare Medicare |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.58
|
| Rate for Payer: UHC Exchange |
$28.80
|
| Rate for Payer: UHC Medicare Advantage |
$18.58
|
| Rate for Payer: UHCCP DNSP |
$18.58
|
| Rate for Payer: UHCCP Medicaid |
$9.96
|
| Rate for Payer: VA VA |
$18.58
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$58.99
|
| Rate for Payer: ASR ASR |
$63.58
|
| Rate for Payer: ASR Commercial |
$63.58
|
| Rate for Payer: BCBS Trust/PPO |
$53.42
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$61.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.58
|
| Rate for Payer: Mclaren Commercial |
$58.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.68
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.10 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna Medicare |
$325.12
|
| Rate for Payer: ASR ASR |
$630.74
|
| Rate for Payer: ASR Commercial |
$630.74
|
| Rate for Payer: BCBS Complete |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$532.49
|
| Rate for Payer: BCN Commercial |
$504.14
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$611.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$650.25
|
| Rate for Payer: Healthscope Whirlpool |
$630.74
|
| Rate for Payer: Mclaren Commercial |
$585.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: Nomi Health Commercial |
$533.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$569.75
|
| Rate for Payer: Priority Health Narrow Network |
$455.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.22
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: ASR ASR |
$630.74
|
| Rate for Payer: ASR Commercial |
$630.74
|
| Rate for Payer: BCBS Trust/PPO |
$529.89
|
| Rate for Payer: BCN Commercial |
$504.14
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$611.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$650.25
|
| Rate for Payer: Healthscope Whirlpool |
$630.74
|
| Rate for Payer: Mclaren Commercial |
$585.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: Nomi Health Commercial |
$533.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.22
|
|
