|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
IP
|
$275.53
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$206.65 |
| Max. Negotiated Rate |
$275.53 |
| Rate for Payer: Aetna Commercial |
$247.98
|
| Rate for Payer: ASR ASR |
$267.26
|
| Rate for Payer: BCBS Trust/PPO |
$226.27
|
| Rate for Payer: BCN Commercial |
$226.27
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cofinity Commercial |
$259.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.42
|
| Rate for Payer: Healthscope Commercial |
$267.26
|
| Rate for Payer: Healthscope Whirlpool |
$275.53
|
| Rate for Payer: Mclaren Commercial |
$247.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.20
|
| Rate for Payer: Nomi Health Commercial |
$225.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.47
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
OP
|
$275.53
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$275.53 |
| Rate for Payer: Aetna Commercial |
$247.98
|
| Rate for Payer: Aetna Medicare |
$101.95
|
| Rate for Payer: ASR ASR |
$267.26
|
| Rate for Payer: BCBS Complete |
$110.21
|
| Rate for Payer: BCBS Trust/PPO |
$227.17
|
| Rate for Payer: BCCCP Commercial |
$119.98
|
| Rate for Payer: BCN Commercial |
$227.17
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cofinity Commercial |
$259.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.42
|
| Rate for Payer: Healthscope Commercial |
$267.26
|
| Rate for Payer: Healthscope Whirlpool |
$275.53
|
| Rate for Payer: Mclaren Commercial |
$247.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.20
|
| Rate for Payer: Nomi Health Commercial |
$225.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$241.42
|
| Rate for Payer: Priority Health Narrow Network |
$193.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.47
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$668.56
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$668.56 |
| Rate for Payer: Aetna Commercial |
$601.70
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$648.50
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$551.23
|
| Rate for Payer: BCCCP Commercial |
$359.30
|
| Rate for Payer: BCN Commercial |
$551.23
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cofinity Commercial |
$628.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$648.50
|
| Rate for Payer: Healthscope Whirlpool |
$668.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$601.70
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.28
|
| Rate for Payer: Nomi Health Commercial |
$548.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.42
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$585.79
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$468.66
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$668.56
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$668.56 |
| Rate for Payer: Aetna Commercial |
$601.70
|
| Rate for Payer: ASR ASR |
$648.50
|
| Rate for Payer: BCBS Trust/PPO |
$549.02
|
| Rate for Payer: BCN Commercial |
$549.02
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cofinity Commercial |
$628.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.85
|
| Rate for Payer: Healthscope Commercial |
$648.50
|
| Rate for Payer: Healthscope Whirlpool |
$668.56
|
| Rate for Payer: Mclaren Commercial |
$601.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.28
|
| Rate for Payer: Nomi Health Commercial |
$548.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.33
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$761.46
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.10 |
| Max. Negotiated Rate |
$761.46 |
| Rate for Payer: Aetna Commercial |
$685.31
|
| Rate for Payer: ASR ASR |
$738.62
|
| Rate for Payer: BCBS Trust/PPO |
$625.31
|
| Rate for Payer: BCN Commercial |
$625.31
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cofinity Commercial |
$715.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.17
|
| Rate for Payer: Healthscope Commercial |
$738.62
|
| Rate for Payer: Healthscope Whirlpool |
$761.46
|
| Rate for Payer: Mclaren Commercial |
$685.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.24
|
| Rate for Payer: Nomi Health Commercial |
$624.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.08
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$761.46
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$1,076.92 |
| Rate for Payer: Aetna Commercial |
$685.31
|
| Rate for Payer: Aetna Medicare |
$694.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: ASR ASR |
$738.62
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$627.82
|
| Rate for Payer: BCN Commercial |
$627.82
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cofinity Commercial |
$715.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$738.62
|
| Rate for Payer: Healthscope Whirlpool |
$761.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$694.79
|
| Rate for Payer: Mclaren Commercial |
$685.31
|
| Rate for Payer: Mclaren Medicaid |
$694.79
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$381.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.24
|
| Rate for Payer: Nomi Health Commercial |
$624.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.10
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$764.27
|
| Rate for Payer: PHP Medicaid |
$372.41
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$535.07
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health Narrow Network |
$428.06
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$1,076.92
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP DNSP |
$694.79
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$680.24
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.18 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Aetna Commercial |
$612.22
|
| Rate for Payer: ASR ASR |
$659.83
|
| Rate for Payer: BCBS Trust/PPO |
$558.61
|
| Rate for Payer: BCN Commercial |
$558.61
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cofinity Commercial |
$639.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.19
|
| Rate for Payer: Healthscope Commercial |
$659.83
|
| Rate for Payer: Healthscope Whirlpool |
$680.24
|
| Rate for Payer: Mclaren Commercial |
$612.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.20
|
| Rate for Payer: Nomi Health Commercial |
$557.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.61
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$680.24
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$680.24 |
| Rate for Payer: Aetna Commercial |
$612.22
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$659.83
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$560.86
|
| Rate for Payer: BCN Commercial |
$560.86
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cofinity Commercial |
$639.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$659.83
|
| Rate for Payer: Healthscope Whirlpool |
$680.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$612.22
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.20
|
| Rate for Payer: Nomi Health Commercial |
$557.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.18
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$596.03
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$476.85
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INSULIN
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC INSULIN
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.07
|
| Rate for Payer: BCN Commercial |
$84.07
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$11.43
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: PHP Medicaid |
$6.13
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.43
|
| Rate for Payer: UHC Exchange |
$17.72
|
| Rate for Payer: UHC Medicaid |
$5.98
|
| Rate for Payer: UHCCP DNSP |
$11.43
|
| Rate for Payer: UHCCP Medicaid |
$5.98
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Trust/PPO |
$58.10
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$257.85 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$58.33
|
| Rate for Payer: BCN Commercial |
$58.33
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.41
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$21.41
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.85
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$206.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.41
|
| Rate for Payer: UHC Exchange |
$33.19
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP DNSP |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$345.01 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$42.00
|
| Rate for Payer: BCN Commercial |
$42.00
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$276.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.83
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$193.58
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$71.62 |
| Max. Negotiated Rate |
$193.58 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna Medicare |
$71.62
|
| Rate for Payer: ASR ASR |
$187.77
|
| Rate for Payer: BCBS Complete |
$77.43
|
| Rate for Payer: BCBS Trust/PPO |
$159.61
|
| Rate for Payer: BCN Commercial |
$159.61
|
| Rate for Payer: Cash Price |
$154.86
|
| Rate for Payer: Cofinity Commercial |
$181.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.86
|
| Rate for Payer: Healthscope Commercial |
$187.77
|
| Rate for Payer: Healthscope Whirlpool |
$193.58
|
| Rate for Payer: Mclaren Commercial |
$174.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.54
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.61
|
| Rate for Payer: Priority Health Narrow Network |
$135.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.35
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$193.58
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$145.19 |
| Max. Negotiated Rate |
$193.58 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: ASR ASR |
$187.77
|
| Rate for Payer: BCBS Trust/PPO |
$158.97
|
| Rate for Payer: BCN Commercial |
$158.97
|
| Rate for Payer: Cash Price |
$154.86
|
| Rate for Payer: Cofinity Commercial |
$181.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.86
|
| Rate for Payer: Healthscope Commercial |
$187.77
|
| Rate for Payer: Healthscope Whirlpool |
$193.58
|
| Rate for Payer: Mclaren Commercial |
$174.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.54
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.35
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,209.35
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.46 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Aetna Commercial |
$1,088.41
|
| Rate for Payer: Aetna Medicare |
$447.46
|
| Rate for Payer: ASR ASR |
$1,173.07
|
| Rate for Payer: BCBS Complete |
$483.74
|
| Rate for Payer: BCBS Trust/PPO |
$997.11
|
| Rate for Payer: BCN Commercial |
$997.11
|
| Rate for Payer: Cash Price |
$967.48
|
| Rate for Payer: Cofinity Commercial |
$1,136.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.48
|
| Rate for Payer: Healthscope Commercial |
$1,173.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,209.35
|
| Rate for Payer: Mclaren Commercial |
$1,088.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$967.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.95
|
| Rate for Payer: Nomi Health Commercial |
$991.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,059.63
|
| Rate for Payer: Priority Health Narrow Network |
$847.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,064.23
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,209.35
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$907.01 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Aetna Commercial |
$1,088.41
|
| Rate for Payer: ASR ASR |
$1,173.07
|
| Rate for Payer: BCBS Trust/PPO |
$993.12
|
| Rate for Payer: BCN Commercial |
$993.12
|
| Rate for Payer: Cash Price |
$967.48
|
| Rate for Payer: Cofinity Commercial |
$1,136.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.48
|
| Rate for Payer: Healthscope Commercial |
$1,173.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,209.35
|
| Rate for Payer: Mclaren Commercial |
$1,088.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.95
|
| Rate for Payer: Nomi Health Commercial |
$991.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,064.23
|
|
|
HC INTERFACE CABLE LEVEL 7
|
Facility
|
OP
|
$1,985.00
|
|
| Hospital Charge Code |
27000721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$734.45 |
| Max. Negotiated Rate |
$1,985.00 |
| Rate for Payer: Aetna Commercial |
$1,786.50
|
| Rate for Payer: Aetna Medicare |
$734.45
|
| Rate for Payer: ASR ASR |
$1,925.45
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.63
|
| Rate for Payer: BCN Commercial |
$1,636.63
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,865.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.00
|
| Rate for Payer: Healthscope Commercial |
$1,925.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,985.00
|
| Rate for Payer: Mclaren Commercial |
$1,786.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,588.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.25
|
| Rate for Payer: Nomi Health Commercial |
$1,627.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,488.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,739.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,391.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,746.80
|
|
|
HC INTERFACE CABLE LEVEL 7
|
Facility
|
IP
|
$1,985.00
|
|
| Hospital Charge Code |
27000721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,488.75 |
| Max. Negotiated Rate |
$1,985.00 |
| Rate for Payer: Aetna Commercial |
$1,786.50
|
| Rate for Payer: ASR ASR |
$1,925.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.08
|
| Rate for Payer: BCN Commercial |
$1,630.08
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,865.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.00
|
| Rate for Payer: Healthscope Commercial |
$1,925.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,985.00
|
| Rate for Payer: Mclaren Commercial |
$1,786.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.25
|
| Rate for Payer: Nomi Health Commercial |
$1,627.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,488.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,746.80
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$134.21
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$345.01 |
| Rate for Payer: Aetna Commercial |
$120.79
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$130.18
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$110.66
|
| Rate for Payer: BCN Commercial |
$110.66
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$130.18
|
| Rate for Payer: Healthscope Whirlpool |
$134.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$120.79
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Nomi Health Commercial |
$110.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$276.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.66 |
| Max. Negotiated Rate |
$134.21 |
| Rate for Payer: Aetna Commercial |
$120.79
|
| Rate for Payer: ASR ASR |
$130.18
|
| Rate for Payer: BCBS Trust/PPO |
$110.21
|
| Rate for Payer: BCN Commercial |
$110.21
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Healthscope Commercial |
$130.18
|
| Rate for Payer: Healthscope Whirlpool |
$134.21
|
| Rate for Payer: Mclaren Commercial |
$120.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Nomi Health Commercial |
$110.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.10
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,994.01
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,745.51 |
| Max. Negotiated Rate |
$4,994.01 |
| Rate for Payer: Aetna Commercial |
$4,494.61
|
| Rate for Payer: ASR ASR |
$4,844.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,101.08
|
| Rate for Payer: BCN Commercial |
$4,101.08
|
| Rate for Payer: Cash Price |
$3,995.21
|
| Rate for Payer: Cofinity Commercial |
$4,694.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.21
|
| Rate for Payer: Healthscope Commercial |
$4,844.19
|
| Rate for Payer: Healthscope Whirlpool |
$4,994.01
|
| Rate for Payer: Mclaren Commercial |
$4,494.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.91
|
| Rate for Payer: Nomi Health Commercial |
$4,095.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,394.73
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$3,024.95
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$2,268.71 |
| Max. Negotiated Rate |
$3,024.95 |
| Rate for Payer: Aetna Commercial |
$2,722.45
|
| Rate for Payer: ASR ASR |
$2,934.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,484.09
|
| Rate for Payer: BCN Commercial |
$2,484.09
|
| Rate for Payer: Cash Price |
$2,419.96
|
| Rate for Payer: Cofinity Commercial |
$2,843.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,419.96
|
| Rate for Payer: Healthscope Commercial |
$2,934.20
|
| Rate for Payer: Healthscope Whirlpool |
$3,024.95
|
| Rate for Payer: Mclaren Commercial |
$2,722.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,571.21
|
| Rate for Payer: Nomi Health Commercial |
$2,480.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,268.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,661.96
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$547.59
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$492.83
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$531.16
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$451.49
|
| Rate for Payer: BCN Commercial |
$451.49
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cofinity Commercial |
$514.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$531.16
|
| Rate for Payer: Healthscope Whirlpool |
$547.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$492.83
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.45
|
| Rate for Payer: Nomi Health Commercial |
$449.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.69
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$481.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
