|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$3,684.41
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$3,970.98
|
| Rate for Payer: ASR Commercial |
$3,970.98
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,352.40
|
| Rate for Payer: BCN Commercial |
$3,173.92
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,848.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$4,093.79
|
| Rate for Payer: Healthscope Whirlpool |
$3,970.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$3,684.41
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,586.98
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,869.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,602.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,592.43 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$10,935.21
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,700.36
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$9,360.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,679.79 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,881.79
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Trust/PPO |
$6,474.81
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$6,506.59
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,961.87
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$5,569.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,679.79 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,881.79
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,592.43 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$10,935.21
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,700.36
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$9,360.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,679.79 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,881.79
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,592.43 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$10,935.21
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,700.36
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$9,360.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$3,684.41
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$3,970.98
|
| Rate for Payer: ASR Commercial |
$3,970.98
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,352.40
|
| Rate for Payer: BCN Commercial |
$3,173.92
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,848.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$4,093.79
|
| Rate for Payer: Healthscope Whirlpool |
$3,970.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$3,684.41
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,586.98
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,869.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,602.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,660.96 |
| Max. Negotiated Rate |
$4,093.79 |
| Rate for Payer: Aetna Commercial |
$3,684.41
|
| Rate for Payer: ASR ASR |
$3,970.98
|
| Rate for Payer: ASR Commercial |
$3,970.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,336.03
|
| Rate for Payer: BCN Commercial |
$3,173.92
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,848.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$4,093.79
|
| Rate for Payer: Healthscope Whirlpool |
$3,970.98
|
| Rate for Payer: Mclaren Commercial |
$3,684.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,602.54
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$86.53
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.40
|
| Rate for Payer: Priority Health Narrow Network |
$61.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,112.10 |
| Max. Negotiated Rate |
$12,176.80 |
| Rate for Payer: Aetna Commercial |
$10,959.12
|
| Rate for Payer: Aetna Medicare |
$2,074.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,593.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,593.51
|
| Rate for Payer: ASR ASR |
$11,811.50
|
| Rate for Payer: ASR Commercial |
$11,811.50
|
| Rate for Payer: BCBS Complete |
$1,167.70
|
| Rate for Payer: BCBS MAPPO |
$2,074.81
|
| Rate for Payer: BCBS Trust/PPO |
$9,971.58
|
| Rate for Payer: BCN Commercial |
$9,440.67
|
| Rate for Payer: BCN Medicare Advantage |
$2,074.81
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$11,446.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,074.81
|
| Rate for Payer: Healthscope Commercial |
$12,176.80
|
| Rate for Payer: Healthscope Whirlpool |
$11,811.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,074.81
|
| Rate for Payer: Mclaren Commercial |
$10,959.12
|
| Rate for Payer: Mclaren Medicaid |
$1,112.10
|
| Rate for Payer: Mclaren Medicare |
$2,074.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,178.55
|
| Rate for Payer: Meridian Medicaid |
$1,167.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,386.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: Nomi Health Commercial |
$9,984.98
|
| Rate for Payer: PACE Medicare |
$1,971.07
|
| Rate for Payer: PACE SWMI |
$2,074.81
|
| Rate for Payer: PHP Commercial |
$2,282.29
|
| Rate for Payer: PHP Medicaid |
$1,112.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,074.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,210.58
|
| Rate for Payer: Priority Health Medicare |
$2,074.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,168.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,074.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,715.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,074.81
|
| Rate for Payer: UHC Exchange |
$3,215.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,074.81
|
| Rate for Payer: UHCCP DNSP |
$2,074.81
|
| Rate for Payer: UHCCP Medicaid |
$1,112.10
|
| Rate for Payer: VA VA |
$2,074.81
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,914.92 |
| Max. Negotiated Rate |
$12,176.80 |
| Rate for Payer: Aetna Commercial |
$10,959.12
|
| Rate for Payer: ASR ASR |
$11,811.50
|
| Rate for Payer: ASR Commercial |
$11,811.50
|
| Rate for Payer: BCBS Trust/PPO |
$9,922.87
|
| Rate for Payer: BCN Commercial |
$9,440.67
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$11,446.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Healthscope Commercial |
$12,176.80
|
| Rate for Payer: Healthscope Whirlpool |
$11,811.50
|
| Rate for Payer: Mclaren Commercial |
$10,959.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: Nomi Health Commercial |
$9,984.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,715.58
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$74.94 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: ASR ASR |
$72.69
|
| Rate for Payer: ASR Commercial |
$72.69
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$74.94
|
| Rate for Payer: Healthscope Whirlpool |
$72.69
|
| Rate for Payer: Mclaren Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: Nomi Health Commercial |
$61.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.95
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$199.47 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Medicare |
$37.47
|
| Rate for Payer: ASR ASR |
$72.69
|
| Rate for Payer: ASR Commercial |
$72.69
|
| Rate for Payer: BCBS Complete |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$61.37
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$74.94
|
| Rate for Payer: Healthscope Whirlpool |
$72.69
|
| Rate for Payer: Mclaren Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: Nomi Health Commercial |
$61.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.47
|
| Rate for Payer: Priority Health Narrow Network |
$159.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.95
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna Commercial |
$61.32
|
| Rate for Payer: Aetna Medicare |
$23.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.91
|
| Rate for Payer: ASR ASR |
$66.09
|
| Rate for Payer: ASR Commercial |
$66.09
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$23.13
|
| Rate for Payer: BCBS Trust/PPO |
$55.79
|
| Rate for Payer: BCN Commercial |
$52.82
|
| Rate for Payer: BCN Medicare Advantage |
$23.13
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.13
|
| Rate for Payer: Healthscope Commercial |
$68.13
|
| Rate for Payer: Healthscope Whirlpool |
$66.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.13
|
| Rate for Payer: Mclaren Commercial |
$61.32
|
| Rate for Payer: Mclaren Medicaid |
$12.40
|
| Rate for Payer: Mclaren Medicare |
$23.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.29
|
| Rate for Payer: Meridian Medicaid |
$13.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: Nomi Health Commercial |
$55.87
|
| Rate for Payer: PACE Medicare |
$21.97
|
| Rate for Payer: PACE SWMI |
$23.13
|
| Rate for Payer: PHP Commercial |
$25.44
|
| Rate for Payer: PHP Medicaid |
$12.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.73
|
| Rate for Payer: Priority Health Medicare |
$23.13
|
| Rate for Payer: Priority Health Narrow Network |
$69.38
|
| Rate for Payer: Railroad Medicare Medicare |
$23.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.13
|
| Rate for Payer: UHC Exchange |
$35.85
|
| Rate for Payer: UHC Medicare Advantage |
$23.13
|
| Rate for Payer: UHCCP DNSP |
$23.13
|
| Rate for Payer: UHCCP Medicaid |
$12.40
|
| Rate for Payer: VA VA |
$23.13
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$68.13 |
| Rate for Payer: Aetna Commercial |
$61.32
|
| Rate for Payer: ASR ASR |
$66.09
|
| Rate for Payer: ASR Commercial |
$66.09
|
| Rate for Payer: BCBS Trust/PPO |
$55.52
|
| Rate for Payer: BCN Commercial |
$52.82
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Healthscope Commercial |
$68.13
|
| Rate for Payer: Healthscope Whirlpool |
$66.09
|
| Rate for Payer: Mclaren Commercial |
$61.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: Nomi Health Commercial |
$55.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.95
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Trust/PPO |
$39.00
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.19
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.60
|
| Rate for Payer: Priority Health Narrow Network |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.01
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: Aetna Medicare |
$23.94
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$39.20
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.49
|
| Rate for Payer: Priority Health Narrow Network |
$5.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: Aetna Medicare |
$20.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.10
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: BCBS MAPPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$39.20
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: BCN Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.88
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Mclaren Medicaid |
$11.19
|
| Rate for Payer: Mclaren Medicare |
$20.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.92
|
| Rate for Payer: Meridian Medicaid |
$11.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: PACE Medicare |
$19.84
|
| Rate for Payer: PACE SWMI |
$20.88
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: PHP Medicaid |
$11.19
|
| Rate for Payer: PHP Medicare Advantage |
$20.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.94
|
| Rate for Payer: Priority Health Medicare |
$20.88
|
| Rate for Payer: Priority Health Narrow Network |
$33.56
|
| Rate for Payer: Railroad Medicare Medicare |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.88
|
| Rate for Payer: UHC Exchange |
$32.36
|
| Rate for Payer: UHC Medicare Advantage |
$20.88
|
| Rate for Payer: UHCCP DNSP |
$20.88
|
| Rate for Payer: UHCCP Medicaid |
$11.19
|
| Rate for Payer: VA VA |
$20.88
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.01
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
|
