|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: ASR Commercial |
$395.76
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$334.11
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.49
|
| Rate for Payer: Priority Health Narrow Network |
$286.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: ASR Commercial |
$395.76
|
| Rate for Payer: BCBS Trust/PPO |
$332.48
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.77 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: ASR ASR |
$420.50
|
| Rate for Payer: ASR Commercial |
$420.50
|
| Rate for Payer: BCBS Trust/PPO |
$353.26
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$407.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$433.50
|
| Rate for Payer: Healthscope Whirlpool |
$420.50
|
| Rate for Payer: Mclaren Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.48
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$216.75
|
| Rate for Payer: ASR ASR |
$420.50
|
| Rate for Payer: ASR Commercial |
$420.50
|
| Rate for Payer: BCBS Complete |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$354.99
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$407.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$433.50
|
| Rate for Payer: Healthscope Whirlpool |
$420.50
|
| Rate for Payer: Mclaren Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.83
|
| Rate for Payer: Priority Health Narrow Network |
$303.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.48
|
|
|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,927.87
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,077.82
|
| Rate for Payer: ASR Commercial |
$2,077.82
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.15
|
| Rate for Payer: BCN Commercial |
$1,660.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$2,013.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,142.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,077.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,927.87
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.89
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,501.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
IP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,392.35 |
| Max. Negotiated Rate |
$2,142.08 |
| Rate for Payer: Aetna Commercial |
$1,927.87
|
| Rate for Payer: ASR ASR |
$2,077.82
|
| Rate for Payer: ASR Commercial |
$2,077.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.58
|
| Rate for Payer: BCN Commercial |
$1,660.75
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$2,013.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Healthscope Commercial |
$2,142.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,077.82
|
| Rate for Payer: Mclaren Commercial |
$1,927.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.03
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$78.65
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$242.35 |
| Rate for Payer: Aetna Commercial |
$218.12
|
| Rate for Payer: ASR ASR |
$235.08
|
| Rate for Payer: ASR Commercial |
$235.08
|
| Rate for Payer: BCBS Trust/PPO |
$197.49
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$227.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Healthscope Commercial |
$242.35
|
| Rate for Payer: Healthscope Whirlpool |
$235.08
|
| Rate for Payer: Mclaren Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.27
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
OP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$242.35 |
| Rate for Payer: Aetna Commercial |
$218.12
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$235.08
|
| Rate for Payer: ASR Commercial |
$235.08
|
| Rate for Payer: BCBS Complete |
$86.39
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$198.46
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$227.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$242.35
|
| Rate for Payer: Healthscope Whirlpool |
$235.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$218.12
|
| Rate for Payer: Mclaren Medicaid |
$82.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$86.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.35
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$169.89
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.93
|
| Rate for Payer: UHC Medicare Advantage |
$153.50
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$82.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
OP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$122.63 |
| Rate for Payer: Aetna Commercial |
$110.37
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$118.95
|
| Rate for Payer: ASR Commercial |
$118.95
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$100.42
|
| Rate for Payer: BCN Commercial |
$95.08
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$122.63
|
| Rate for Payer: Healthscope Whirlpool |
$118.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$110.37
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.45
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$85.96
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$122.63 |
| Rate for Payer: Aetna Commercial |
$110.37
|
| Rate for Payer: ASR ASR |
$118.95
|
| Rate for Payer: ASR Commercial |
$118.95
|
| Rate for Payer: BCBS Trust/PPO |
$99.93
|
| Rate for Payer: BCN Commercial |
$95.08
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$122.63
|
| Rate for Payer: Healthscope Whirlpool |
$118.95
|
| Rate for Payer: Mclaren Commercial |
$110.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.91
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$338.23 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$328.08
|
| Rate for Payer: ASR Commercial |
$328.08
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$276.98
|
| Rate for Payer: BCN Commercial |
$262.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$317.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$338.23
|
| Rate for Payer: Healthscope Whirlpool |
$328.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$304.41
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.36
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$237.10
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.37
|
| Rate for Payer: VA VA |
$11.89
|
|
