|
HC IMPELLA MONITORING KIT
|
Facility
|
IP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$305.50
|
| Rate for Payer: ASR ASR |
$329.27
|
| Rate for Payer: ASR Commercial |
$329.27
|
| Rate for Payer: BCBS Trust/PPO |
$276.62
|
| Rate for Payer: BCN Commercial |
$263.18
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$319.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$339.45
|
| Rate for Payer: Healthscope Whirlpool |
$329.27
|
| Rate for Payer: Mclaren Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: Nomi Health Commercial |
$278.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.72
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
OP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.78 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$305.50
|
| Rate for Payer: Aetna Medicare |
$169.72
|
| Rate for Payer: ASR ASR |
$329.27
|
| Rate for Payer: ASR Commercial |
$329.27
|
| Rate for Payer: BCBS Complete |
$135.78
|
| Rate for Payer: BCBS Trust/PPO |
$277.98
|
| Rate for Payer: BCN Commercial |
$263.18
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$319.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$339.45
|
| Rate for Payer: Healthscope Whirlpool |
$329.27
|
| Rate for Payer: Mclaren Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: Nomi Health Commercial |
$278.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.43
|
| Rate for Payer: Priority Health Narrow Network |
$237.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.72
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
IP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,904.88 |
| Max. Negotiated Rate |
$2,930.58 |
| Rate for Payer: Aetna Commercial |
$2,637.52
|
| Rate for Payer: ASR ASR |
$2,842.66
|
| Rate for Payer: ASR Commercial |
$2,842.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,388.13
|
| Rate for Payer: BCN Commercial |
$2,272.08
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,754.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,930.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.66
|
| Rate for Payer: Mclaren Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: Nomi Health Commercial |
$2,403.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,578.91
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
OP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,172.23 |
| Max. Negotiated Rate |
$2,930.58 |
| Rate for Payer: Aetna Commercial |
$2,637.52
|
| Rate for Payer: Aetna Medicare |
$1,465.29
|
| Rate for Payer: ASR ASR |
$2,842.66
|
| Rate for Payer: ASR Commercial |
$2,842.66
|
| Rate for Payer: BCBS Complete |
$1,172.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.85
|
| Rate for Payer: BCN Commercial |
$2,272.08
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,754.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,930.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.66
|
| Rate for Payer: Mclaren Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: Nomi Health Commercial |
$2,403.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,567.77
|
| Rate for Payer: Priority Health Narrow Network |
$2,054.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,578.91
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
IP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,031.71 |
| Max. Negotiated Rate |
$6,202.63 |
| Rate for Payer: Aetna Commercial |
$5,582.37
|
| Rate for Payer: ASR ASR |
$6,016.55
|
| Rate for Payer: ASR Commercial |
$6,016.55
|
| Rate for Payer: BCBS Trust/PPO |
$5,054.52
|
| Rate for Payer: BCN Commercial |
$4,808.90
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$5,830.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Healthscope Commercial |
$6,202.63
|
| Rate for Payer: Healthscope Whirlpool |
$6,016.55
|
| Rate for Payer: Mclaren Commercial |
$5,582.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: Nomi Health Commercial |
$5,086.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,458.31
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
OP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,031.71 |
| Max. Negotiated Rate |
$42,974.65 |
| Rate for Payer: Aetna Commercial |
$5,582.37
|
| Rate for Payer: Aetna Medicare |
$27,725.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,656.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,656.97
|
| Rate for Payer: ASR ASR |
$6,016.55
|
| Rate for Payer: ASR Commercial |
$6,016.55
|
| Rate for Payer: BCBS Complete |
$15,603.96
|
| Rate for Payer: BCBS MAPPO |
$27,725.58
|
| Rate for Payer: BCBS Trust/PPO |
$5,079.33
|
| Rate for Payer: BCN Commercial |
$4,808.90
|
| Rate for Payer: BCN Medicare Advantage |
$27,725.58
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$5,830.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,725.58
|
| Rate for Payer: Healthscope Commercial |
$6,202.63
|
| Rate for Payer: Healthscope Whirlpool |
$6,016.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,725.58
|
| Rate for Payer: Mclaren Commercial |
$5,582.37
|
| Rate for Payer: Mclaren Medicaid |
$14,860.91
|
| Rate for Payer: Mclaren Medicare |
$27,725.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,111.86
|
| Rate for Payer: Meridian Medicaid |
$15,603.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,884.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: Nomi Health Commercial |
$5,086.16
|
| Rate for Payer: PACE Medicare |
$26,339.30
|
| Rate for Payer: PACE SWMI |
$27,725.58
|
| Rate for Payer: PHP Commercial |
$30,498.14
|
| Rate for Payer: PHP Medicaid |
$14,860.91
|
| Rate for Payer: PHP Medicare Advantage |
$27,725.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,860.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,434.74
|
| Rate for Payer: Priority Health Medicare |
$27,725.58
|
| Rate for Payer: Priority Health Narrow Network |
$4,348.04
|
| Rate for Payer: Railroad Medicare Medicare |
$27,725.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,458.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,725.58
|
| Rate for Payer: UHC Exchange |
$42,974.65
|
| Rate for Payer: UHC Medicare Advantage |
$27,725.58
|
| Rate for Payer: UHCCP DNSP |
$27,725.58
|
| Rate for Payer: UHCCP Medicaid |
$14,860.91
|
| Rate for Payer: VA VA |
$27,725.58
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
IP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46,890.93 |
| Max. Negotiated Rate |
$72,139.89 |
| Rate for Payer: Aetna Commercial |
$64,925.90
|
| Rate for Payer: ASR ASR |
$69,975.69
|
| Rate for Payer: ASR Commercial |
$69,975.69
|
| Rate for Payer: BCBS Trust/PPO |
$58,786.80
|
| Rate for Payer: BCN Commercial |
$55,930.06
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$67,811.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$72,139.89
|
| Rate for Payer: Healthscope Whirlpool |
$69,975.69
|
| Rate for Payer: Mclaren Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: Nomi Health Commercial |
$59,154.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63,483.10
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
OP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28,855.96 |
| Max. Negotiated Rate |
$72,139.89 |
| Rate for Payer: Aetna Commercial |
$64,925.90
|
| Rate for Payer: Aetna Medicare |
$36,069.94
|
| Rate for Payer: ASR ASR |
$69,975.69
|
| Rate for Payer: ASR Commercial |
$69,975.69
|
| Rate for Payer: BCBS Complete |
$28,855.96
|
| Rate for Payer: BCBS Trust/PPO |
$59,075.36
|
| Rate for Payer: BCN Commercial |
$55,930.06
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$67,811.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$72,139.89
|
| Rate for Payer: Healthscope Whirlpool |
$69,975.69
|
| Rate for Payer: Mclaren Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: Nomi Health Commercial |
$59,154.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63,208.97
|
| Rate for Payer: Priority Health Narrow Network |
$50,570.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63,483.10
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
IP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.16 |
| Max. Negotiated Rate |
$543.33 |
| Rate for Payer: Aetna Commercial |
$489.00
|
| Rate for Payer: ASR ASR |
$527.03
|
| Rate for Payer: ASR Commercial |
$527.03
|
| Rate for Payer: BCBS Trust/PPO |
$442.76
|
| Rate for Payer: BCN Commercial |
$421.24
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$510.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Healthscope Commercial |
$543.33
|
| Rate for Payer: Healthscope Whirlpool |
$527.03
|
| Rate for Payer: Mclaren Commercial |
$489.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: Nomi Health Commercial |
$445.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.13
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
OP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$603.23 |
| Rate for Payer: Aetna Commercial |
$489.00
|
| Rate for Payer: Aetna Medicare |
$389.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: ASR ASR |
$527.03
|
| Rate for Payer: ASR Commercial |
$527.03
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCBS Trust/PPO |
$444.93
|
| Rate for Payer: BCN Commercial |
$421.24
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$510.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$543.33
|
| Rate for Payer: Healthscope Whirlpool |
$527.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.18
|
| Rate for Payer: Mclaren Commercial |
$489.00
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: Nomi Health Commercial |
$445.53
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$428.10
|
| Rate for Payer: PHP Medicaid |
$208.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.07
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Priority Health Narrow Network |
$380.87
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$603.23
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP DNSP |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$7,125.70 |
| Rate for Payer: Aetna Commercial |
$6,413.13
|
| Rate for Payer: Aetna Medicare |
$1,334.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,668.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,668.05
|
| Rate for Payer: ASR ASR |
$6,911.93
|
| Rate for Payer: ASR Commercial |
$6,911.93
|
| Rate for Payer: BCBS Complete |
$751.02
|
| Rate for Payer: BCBS MAPPO |
$1,334.44
|
| Rate for Payer: BCBS Trust/PPO |
$5,835.24
|
| Rate for Payer: BCN Commercial |
$5,524.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,334.44
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$6,698.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,334.44
|
| Rate for Payer: Healthscope Commercial |
$7,125.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,911.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,334.44
|
| Rate for Payer: Mclaren Commercial |
$6,413.13
|
| Rate for Payer: Mclaren Medicaid |
$715.26
|
| Rate for Payer: Mclaren Medicare |
$1,334.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,401.16
|
| Rate for Payer: Meridian Medicaid |
$751.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.85
|
| Rate for Payer: Nomi Health Commercial |
$5,843.07
|
| Rate for Payer: PACE Medicare |
$1,267.72
|
| Rate for Payer: PACE SWMI |
$1,334.44
|
| Rate for Payer: PHP Commercial |
$1,467.88
|
| Rate for Payer: PHP Medicaid |
$715.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,334.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,243.54
|
| Rate for Payer: Priority Health Medicare |
$1,334.44
|
| Rate for Payer: Priority Health Narrow Network |
$4,995.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,270.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,334.44
|
| Rate for Payer: UHC Exchange |
$2,068.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,334.44
|
| Rate for Payer: UHCCP DNSP |
$1,334.44
|
| Rate for Payer: UHCCP Medicaid |
$715.26
|
| Rate for Payer: VA VA |
$1,334.44
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,631.70 |
| Max. Negotiated Rate |
$7,125.70 |
| Rate for Payer: Aetna Commercial |
$6,413.13
|
| Rate for Payer: ASR ASR |
$6,911.93
|
| Rate for Payer: ASR Commercial |
$6,911.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,806.73
|
| Rate for Payer: BCN Commercial |
$5,524.56
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$6,698.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Healthscope Commercial |
$7,125.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,911.93
|
| Rate for Payer: Mclaren Commercial |
$6,413.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.85
|
| Rate for Payer: Nomi Health Commercial |
$5,843.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,270.62
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
IP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$509.62 |
| Max. Negotiated Rate |
$784.03 |
| Rate for Payer: Aetna Commercial |
$705.63
|
| Rate for Payer: ASR ASR |
$760.51
|
| Rate for Payer: ASR Commercial |
$760.51
|
| Rate for Payer: BCBS Trust/PPO |
$638.91
|
| Rate for Payer: BCN Commercial |
$607.86
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$736.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Healthscope Commercial |
$784.03
|
| Rate for Payer: Healthscope Whirlpool |
$760.51
|
| Rate for Payer: Mclaren Commercial |
$705.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: Nomi Health Commercial |
$642.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.95
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
OP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$509.62 |
| Max. Negotiated Rate |
$1,598.65 |
| Rate for Payer: Aetna Commercial |
$705.63
|
| Rate for Payer: Aetna Medicare |
$1,031.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,289.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,289.24
|
| Rate for Payer: ASR ASR |
$760.51
|
| Rate for Payer: ASR Commercial |
$760.51
|
| Rate for Payer: BCBS Complete |
$580.47
|
| Rate for Payer: BCBS MAPPO |
$1,031.39
|
| Rate for Payer: BCBS Trust/PPO |
$642.04
|
| Rate for Payer: BCN Commercial |
$607.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,031.39
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$736.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$784.03
|
| Rate for Payer: Healthscope Whirlpool |
$760.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,031.39
|
| Rate for Payer: Mclaren Commercial |
$705.63
|
| Rate for Payer: Mclaren Medicaid |
$552.83
|
| Rate for Payer: Mclaren Medicare |
$1,031.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,082.96
|
| Rate for Payer: Meridian Medicaid |
$580.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,186.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: Nomi Health Commercial |
$642.90
|
| Rate for Payer: PACE Medicare |
$979.82
|
| Rate for Payer: PACE SWMI |
$1,031.39
|
| Rate for Payer: PHP Commercial |
$1,134.53
|
| Rate for Payer: PHP Medicaid |
$552.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,031.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.97
|
| Rate for Payer: Priority Health Medicare |
$1,031.39
|
| Rate for Payer: Priority Health Narrow Network |
$549.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,031.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,031.39
|
| Rate for Payer: UHC Exchange |
$1,598.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,031.39
|
| Rate for Payer: UHCCP DNSP |
$1,031.39
|
| Rate for Payer: UHCCP Medicaid |
$552.83
|
| Rate for Payer: VA VA |
$1,031.39
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
OP
|
$5,411.53
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,026.23 |
| Max. Negotiated Rate |
$5,411.53 |
| Rate for Payer: Aetna Commercial |
$4,870.38
|
| Rate for Payer: Aetna Medicare |
$1,914.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.26
|
| Rate for Payer: ASR ASR |
$5,249.18
|
| Rate for Payer: ASR Commercial |
$5,249.18
|
| Rate for Payer: BCBS Complete |
$1,077.54
|
| Rate for Payer: BCBS MAPPO |
$1,914.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,431.50
|
| Rate for Payer: BCN Commercial |
$4,195.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,914.61
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cofinity Commercial |
$5,086.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,914.61
|
| Rate for Payer: Healthscope Commercial |
$5,411.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,249.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,914.61
|
| Rate for Payer: Mclaren Commercial |
$4,870.38
|
| Rate for Payer: Mclaren Medicaid |
$1,026.23
|
| Rate for Payer: Mclaren Medicare |
$1,914.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.34
|
| Rate for Payer: Meridian Medicaid |
$1,077.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,201.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,599.80
|
| Rate for Payer: Nomi Health Commercial |
$4,437.45
|
| Rate for Payer: PACE Medicare |
$1,818.88
|
| Rate for Payer: PACE SWMI |
$1,914.61
|
| Rate for Payer: PHP Commercial |
$2,106.07
|
| Rate for Payer: PHP Medicaid |
$1,026.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,914.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,741.58
|
| Rate for Payer: Priority Health Medicare |
$1,914.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,793.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,914.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,762.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,914.61
|
| Rate for Payer: UHC Exchange |
$2,967.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,914.61
|
| Rate for Payer: UHCCP DNSP |
$1,914.61
|
| Rate for Payer: UHCCP Medicaid |
$1,026.23
|
| Rate for Payer: VA VA |
$1,914.61
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
IP
|
$5,411.53
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,517.49 |
| Max. Negotiated Rate |
$5,411.53 |
| Rate for Payer: Aetna Commercial |
$4,870.38
|
| Rate for Payer: ASR ASR |
$5,249.18
|
| Rate for Payer: ASR Commercial |
$5,249.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,409.86
|
| Rate for Payer: BCN Commercial |
$4,195.56
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cofinity Commercial |
$5,086.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.22
|
| Rate for Payer: Healthscope Commercial |
$5,411.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,249.18
|
| Rate for Payer: Mclaren Commercial |
$4,870.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,599.80
|
| Rate for Payer: Nomi Health Commercial |
$4,437.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,762.15
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
IP
|
$5,517.33
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,586.26 |
| Max. Negotiated Rate |
$5,517.33 |
| Rate for Payer: Aetna Commercial |
$4,965.60
|
| Rate for Payer: ASR ASR |
$5,351.81
|
| Rate for Payer: ASR Commercial |
$5,351.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,496.07
|
| Rate for Payer: BCN Commercial |
$4,277.59
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cofinity Commercial |
$5,186.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,413.86
|
| Rate for Payer: Healthscope Commercial |
$5,517.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,351.81
|
| Rate for Payer: Mclaren Commercial |
$4,965.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,689.73
|
| Rate for Payer: Nomi Health Commercial |
$4,524.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,855.25
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
OP
|
$5,517.33
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,517.33 |
| Rate for Payer: Aetna Commercial |
$4,965.60
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: ASR ASR |
$5,351.81
|
| Rate for Payer: ASR Commercial |
$5,351.81
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,518.14
|
| Rate for Payer: BCN Commercial |
$4,277.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cofinity Commercial |
$5,186.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,413.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$5,517.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,351.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$4,965.60
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,689.73
|
| Rate for Payer: Nomi Health Commercial |
$4,524.21
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,834.28
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,867.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,855.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$111.32
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$100.19
|
| Rate for Payer: ASR ASR |
$107.98
|
| Rate for Payer: ASR Commercial |
$107.98
|
| Rate for Payer: BCBS Trust/PPO |
$90.71
|
| Rate for Payer: BCN Commercial |
$86.31
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$111.32
|
| Rate for Payer: Healthscope Whirlpool |
$107.98
|
| Rate for Payer: Mclaren Commercial |
$100.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.62
|
| Rate for Payer: Nomi Health Commercial |
$91.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.96
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$111.32
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$100.19
|
| Rate for Payer: Aetna Medicare |
$55.66
|
| Rate for Payer: ASR ASR |
$107.98
|
| Rate for Payer: ASR Commercial |
$107.98
|
| Rate for Payer: BCBS Complete |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$91.16
|
| Rate for Payer: BCN Commercial |
$86.31
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$111.32
|
| Rate for Payer: Healthscope Whirlpool |
$107.98
|
| Rate for Payer: Mclaren Commercial |
$100.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.62
|
| Rate for Payer: Nomi Health Commercial |
$91.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.54
|
| Rate for Payer: Priority Health Narrow Network |
$78.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.96
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$490.03
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.52 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$475.33
|
| Rate for Payer: ASR Commercial |
$475.33
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$401.29
|
| Rate for Payer: BCN Commercial |
$379.92
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$460.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$490.03
|
| Rate for Payer: Healthscope Whirlpool |
$475.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$441.03
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.36
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$343.51
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$490.03
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.52 |
| Max. Negotiated Rate |
$490.03 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: ASR ASR |
$475.33
|
| Rate for Payer: ASR Commercial |
$475.33
|
| Rate for Payer: BCBS Trust/PPO |
$399.33
|
| Rate for Payer: BCN Commercial |
$379.92
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$460.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Healthscope Commercial |
$490.03
|
| Rate for Payer: Healthscope Whirlpool |
$475.33
|
| Rate for Payer: Mclaren Commercial |
$441.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.23
|
|
|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
OP
|
$2,004.12
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$801.65 |
| Max. Negotiated Rate |
$2,004.12 |
| Rate for Payer: Aetna Commercial |
$1,803.71
|
| Rate for Payer: Aetna Medicare |
$1,002.06
|
| Rate for Payer: ASR ASR |
$1,944.00
|
| Rate for Payer: ASR Commercial |
$1,944.00
|
| Rate for Payer: BCBS Complete |
$801.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.17
|
| Rate for Payer: BCN Commercial |
$1,553.79
|
| Rate for Payer: Cash Price |
$1,603.30
|
| Rate for Payer: Cofinity Commercial |
$1,883.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.30
|
| Rate for Payer: Healthscope Commercial |
$2,004.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.00
|
| Rate for Payer: Mclaren Commercial |
$1,803.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.50
|
| Rate for Payer: Nomi Health Commercial |
$1,643.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,756.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.63
|
|
|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
IP
|
$2,004.12
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.68 |
| Max. Negotiated Rate |
$2,004.12 |
| Rate for Payer: Aetna Commercial |
$1,803.71
|
| Rate for Payer: ASR ASR |
$1,944.00
|
| Rate for Payer: ASR Commercial |
$1,944.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,633.16
|
| Rate for Payer: BCN Commercial |
$1,553.79
|
| Rate for Payer: Cash Price |
$1,603.30
|
| Rate for Payer: Cofinity Commercial |
$1,883.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.30
|
| Rate for Payer: Healthscope Commercial |
$2,004.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.00
|
| Rate for Payer: Mclaren Commercial |
$1,803.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.50
|
| Rate for Payer: Nomi Health Commercial |
$1,643.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.63
|
|
|
HC INCISION & DRAIN ABSCESS PERITONSILLAR
|
Facility
|
OP
|
$628.32
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$628.32 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Aetna Medicare |
$226.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: ASR ASR |
$609.47
|
| Rate for Payer: ASR Commercial |
$609.47
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCBS Trust/PPO |
$514.53
|
| Rate for Payer: BCN Commercial |
$487.14
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$590.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$628.32
|
| Rate for Payer: Healthscope Whirlpool |
$609.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$226.48
|
| Rate for Payer: Mclaren Commercial |
$565.49
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: Nomi Health Commercial |
$515.22
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Commercial |
$249.13
|
| Rate for Payer: PHP Medicaid |
$121.39
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.53
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Priority Health Narrow Network |
$440.45
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$552.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$351.04
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP DNSP |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
