|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$566.15
|
| Rate for Payer: BCN Commercial |
$566.15
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Trust/PPO |
$563.89
|
| Rate for Payer: BCN Commercial |
$563.89
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: BCBS Trust/PPO |
$74.33
|
| Rate for Payer: BCN Commercial |
$74.33
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$87.79
|
| Rate for Payer: Healthscope Whirlpool |
$90.51
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.63
|
| Rate for Payer: BCN Commercial |
$74.63
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$87.79
|
| Rate for Payer: Healthscope Whirlpool |
$90.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.81
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Mclaren Medicaid |
$22.81
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PHP Commercial |
$25.09
|
| Rate for Payer: PHP Medicaid |
$12.23
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health Narrow Network |
$63.45
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Exchange |
$35.36
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHCCP DNSP |
$22.81
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: VA VA |
$22.81
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$69.02 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Medicare |
$27.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.96
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: BCBS Complete |
$14.92
|
| Rate for Payer: BCBS MAPPO |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.10
|
| Rate for Payer: BCN Commercial |
$40.10
|
| Rate for Payer: BCN Medicare Advantage |
$27.17
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Healthscope Whirlpool |
$48.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.17
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Mclaren Medicaid |
$27.17
|
| Rate for Payer: Mclaren Medicare |
$27.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.53
|
| Rate for Payer: Meridian Medicaid |
$14.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.48
|
| Rate for Payer: PACE Medicare |
$25.81
|
| Rate for Payer: PACE SWMI |
$27.17
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicaid |
$14.56
|
| Rate for Payer: PHP Medicare Advantage |
$27.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.02
|
| Rate for Payer: Priority Health Medicare |
$27.17
|
| Rate for Payer: Priority Health Narrow Network |
$55.21
|
| Rate for Payer: Railroad Medicare Medicare |
$27.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.17
|
| Rate for Payer: UHC Exchange |
$42.11
|
| Rate for Payer: UHC Medicaid |
$14.21
|
| Rate for Payer: UHCCP DNSP |
$27.17
|
| Rate for Payer: UHCCP Medicaid |
$14.21
|
| Rate for Payer: VA VA |
$27.17
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.94
|
| Rate for Payer: BCN Commercial |
$39.94
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Healthscope Whirlpool |
$48.64
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
IP
|
$28.65
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$25.79
|
| Rate for Payer: ASR ASR |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$23.53
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Healthscope Whirlpool |
$28.65
|
| Rate for Payer: Mclaren Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$23.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.21
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
OP
|
$28.65
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$25.79
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: ASR ASR |
$27.79
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$23.62
|
| Rate for Payer: BCN Commercial |
$23.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Healthscope Whirlpool |
$28.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.25
|
| Rate for Payer: Mclaren Commercial |
$25.79
|
| Rate for Payer: Mclaren Medicaid |
$12.25
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: Meridian Medicaid |
$6.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$23.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.47
|
| Rate for Payer: PHP Medicaid |
$6.57
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.10
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health Narrow Network |
$20.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.25
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicaid |
$6.41
|
| Rate for Payer: UHCCP DNSP |
$12.25
|
| Rate for Payer: UHCCP Medicaid |
$6.41
|
| Rate for Payer: VA VA |
$12.25
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$15.05
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.03
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$20.83
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicaid |
$7.87
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.40
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
IP
|
$23.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$20.89
|
| Rate for Payer: ASR ASR |
$22.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$22.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.73
|
| Rate for Payer: Nomi Health Commercial |
$19.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.42
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
OP
|
$23.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$20.89
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: ASR ASR |
$22.51
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$19.14
|
| Rate for Payer: BCN Commercial |
$19.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$22.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.82
|
| Rate for Payer: Mclaren Commercial |
$20.89
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$4.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.73
|
| Rate for Payer: Nomi Health Commercial |
$19.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.41
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$8.60
|
| Rate for Payer: PHP Medicaid |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.34
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$16.27
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.82
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicaid |
$4.09
|
| Rate for Payer: UHCCP DNSP |
$7.82
|
| Rate for Payer: UHCCP Medicaid |
$4.09
|
| Rate for Payer: VA VA |
$7.82
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,175.67
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,131.75 |
| Max. Negotiated Rate |
$4,175.67 |
| Rate for Payer: Aetna Commercial |
$3,758.10
|
| Rate for Payer: ASR ASR |
$4,050.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,429.06
|
| Rate for Payer: BCN Commercial |
$3,429.06
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Commercial |
$3,925.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Healthscope Commercial |
$4,050.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,175.67
|
| Rate for Payer: Mclaren Commercial |
$3,758.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$3,424.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,674.59
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,175.67
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$4,999.51 |
| Rate for Payer: Aetna Commercial |
$3,758.10
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$4,050.40
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,442.84
|
| Rate for Payer: BCN Commercial |
$3,442.84
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Commercial |
$3,925.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$4,050.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,175.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$3,758.10
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$3,424.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,658.72
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,927.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,674.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: Aetna Medicare |
$4,984.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,230.18
|
| Rate for Payer: BCN Commercial |
$11,230.18
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,984.46
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$2,737.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$5,482.91
|
| Rate for Payer: PHP Medicaid |
$2,671.67
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,934.37
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Narrow Network |
$9,548.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$7,725.91
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP DNSP |
$4,984.46
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,215.45 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Trust/PPO |
$11,185.24
|
| Rate for Payer: BCN Commercial |
$11,185.24
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$8,104.44 |
| Rate for Payer: Aetna Commercial |
$7,294.00
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$7,861.31
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,682.11
|
| Rate for Payer: BCN Commercial |
$6,682.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$7,618.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,861.31
|
| Rate for Payer: Healthscope Whirlpool |
$8,104.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$7,294.00
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,101.11
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$5,681.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,131.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,078.33 |
| Max. Negotiated Rate |
$8,104.44 |
| Rate for Payer: Aetna Commercial |
$7,294.00
|
| Rate for Payer: ASR ASR |
$7,861.31
|
| Rate for Payer: BCBS Trust/PPO |
$6,655.37
|
| Rate for Payer: BCN Commercial |
$6,655.37
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$7,618.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,861.31
|
| Rate for Payer: Healthscope Whirlpool |
$8,104.44
|
| Rate for Payer: Mclaren Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,131.91
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: Aetna Medicare |
$4,984.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,230.18
|
| Rate for Payer: BCN Commercial |
$11,230.18
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,984.46
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$2,737.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$5,482.91
|
| Rate for Payer: PHP Medicaid |
$2,671.67
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,934.37
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Narrow Network |
$9,548.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$7,725.91
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP DNSP |
$4,984.46
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,215.45 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Trust/PPO |
$11,185.24
|
| Rate for Payer: BCN Commercial |
$11,185.24
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,215.45 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Trust/PPO |
$11,185.24
|
| Rate for Payer: BCN Commercial |
$11,185.24
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$13,620.60 |
| Rate for Payer: Aetna Commercial |
$12,258.54
|
| Rate for Payer: Aetna Medicare |
$4,984.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: ASR ASR |
$13,211.98
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,230.18
|
| Rate for Payer: BCN Commercial |
$11,230.18
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Commercial |
$12,803.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$13,211.98
|
| Rate for Payer: Healthscope Whirlpool |
$13,620.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,984.46
|
| Rate for Payer: Mclaren Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$2,737.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$11,168.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$5,482.91
|
| Rate for Payer: PHP Medicaid |
$2,671.67
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,934.37
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Narrow Network |
$9,548.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,986.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$7,725.91
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP DNSP |
$4,984.46
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,175.67
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$4,999.51 |
| Rate for Payer: Aetna Commercial |
$3,758.10
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$4,050.40
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,442.84
|
| Rate for Payer: BCN Commercial |
$3,442.84
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Commercial |
$3,925.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$4,050.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,175.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$3,758.10
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$3,424.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,658.72
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,927.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,674.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,175.67
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,131.75 |
| Max. Negotiated Rate |
$4,175.67 |
| Rate for Payer: Aetna Commercial |
$3,758.10
|
| Rate for Payer: ASR ASR |
$4,050.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,429.06
|
| Rate for Payer: BCN Commercial |
$3,429.06
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Commercial |
$3,925.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Healthscope Commercial |
$4,050.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,175.67
|
| Rate for Payer: Mclaren Commercial |
$3,758.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$3,424.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,674.59
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Complete |
$43.11
|
| Rate for Payer: BCBS Trust/PPO |
$88.86
|
| Rate for Payer: BCN Commercial |
$88.86
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.33
|
| Rate for Payer: Priority Health Narrow Network |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
|
