|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$449.40
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$449.46 |
| Rate for Payer: Aetna Commercial |
$404.46
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$435.92
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$348.42
|
| Rate for Payer: BCN Commercial |
$348.42
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cofinity Commercial |
$422.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$449.40
|
| Rate for Payer: Healthscope Whirlpool |
$435.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$404.46
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.99
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$449.46
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$359.57
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.47
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$449.40
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$449.40 |
| Rate for Payer: Aetna Commercial |
$404.46
|
| Rate for Payer: ASR ASR |
$435.92
|
| Rate for Payer: BCBS Trust/PPO |
$348.42
|
| Rate for Payer: BCN Commercial |
$348.42
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cofinity Commercial |
$422.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.52
|
| Rate for Payer: Healthscope Commercial |
$449.40
|
| Rate for Payer: Healthscope Whirlpool |
$435.92
|
| Rate for Payer: Mclaren Commercial |
$404.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.47
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$390.46
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$390.46 |
| Rate for Payer: Aetna Commercial |
$351.41
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$378.75
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$302.72
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cofinity Commercial |
$367.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$390.46
|
| Rate for Payer: Healthscope Whirlpool |
$378.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$351.41
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.89
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$291.85
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.60
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$390.46
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$390.46 |
| Rate for Payer: Aetna Commercial |
$351.41
|
| Rate for Payer: ASR ASR |
$378.75
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$302.72
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cofinity Commercial |
$367.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.37
|
| Rate for Payer: Healthscope Commercial |
$390.46
|
| Rate for Payer: Healthscope Whirlpool |
$378.75
|
| Rate for Payer: Mclaren Commercial |
$351.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.60
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,067.65
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$1,067.65 |
| Rate for Payer: Aetna Commercial |
$960.88
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$1,035.62
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$827.75
|
| Rate for Payer: BCN Commercial |
$827.75
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cofinity Commercial |
$1,003.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$1,067.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$960.88
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$907.50
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.56
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$758.03
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.53
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,067.65
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$747.36 |
| Max. Negotiated Rate |
$1,067.65 |
| Rate for Payer: Aetna Commercial |
$960.88
|
| Rate for Payer: ASR ASR |
$1,035.62
|
| Rate for Payer: BCBS Trust/PPO |
$827.75
|
| Rate for Payer: BCN Commercial |
$827.75
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cofinity Commercial |
$1,003.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.12
|
| Rate for Payer: Healthscope Commercial |
$1,067.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.62
|
| Rate for Payer: Mclaren Commercial |
$960.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$907.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.53
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,342.18
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$1,401.76 |
| Rate for Payer: Aetna Commercial |
$1,207.96
|
| Rate for Payer: Aetna Medicare |
$805.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: ASR ASR |
$1,301.91
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.59
|
| Rate for Payer: BCN Commercial |
$1,040.59
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cofinity Commercial |
$1,261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$1,342.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,301.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$1,207.96
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,140.85
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$886.32
|
| Rate for Payer: PHP Medicaid |
$440.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,401.76
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,121.41
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.12
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,342.18
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.53 |
| Max. Negotiated Rate |
$1,342.18 |
| Rate for Payer: Aetna Commercial |
$1,207.96
|
| Rate for Payer: ASR ASR |
$1,301.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.59
|
| Rate for Payer: BCN Commercial |
$1,040.59
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cofinity Commercial |
$1,261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.74
|
| Rate for Payer: Healthscope Commercial |
$1,342.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,301.91
|
| Rate for Payer: Mclaren Commercial |
$1,207.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,140.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.12
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$500.38 |
| Rate for Payer: Aetna Commercial |
$450.34
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$485.37
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$387.94
|
| Rate for Payer: BCN Commercial |
$387.94
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$470.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$500.38
|
| Rate for Payer: Healthscope Whirlpool |
$485.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$450.34
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.78
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.33
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.27 |
| Max. Negotiated Rate |
$500.38 |
| Rate for Payer: Aetna Commercial |
$450.34
|
| Rate for Payer: ASR ASR |
$485.37
|
| Rate for Payer: BCBS Trust/PPO |
$387.94
|
| Rate for Payer: BCN Commercial |
$387.94
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$470.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$500.38
|
| Rate for Payer: Healthscope Whirlpool |
$485.37
|
| Rate for Payer: Mclaren Commercial |
$450.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.33
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$900.70
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$900.70 |
| Rate for Payer: Aetna Commercial |
$810.63
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$873.68
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$698.31
|
| Rate for Payer: BCN Commercial |
$698.31
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$846.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$900.70
|
| Rate for Payer: Healthscope Whirlpool |
$873.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$810.63
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.37
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$341.10
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.62
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$900.70
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$630.49 |
| Max. Negotiated Rate |
$900.70 |
| Rate for Payer: Aetna Commercial |
$810.63
|
| Rate for Payer: ASR ASR |
$873.68
|
| Rate for Payer: BCBS Trust/PPO |
$698.31
|
| Rate for Payer: BCN Commercial |
$698.31
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$846.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.56
|
| Rate for Payer: Healthscope Commercial |
$900.70
|
| Rate for Payer: Healthscope Whirlpool |
$873.68
|
| Rate for Payer: Mclaren Commercial |
$810.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.62
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$370.48
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$370.48 |
| Rate for Payer: Aetna Commercial |
$333.43
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$359.37
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$287.23
|
| Rate for Payer: BCN Commercial |
$287.23
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$348.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$370.48
|
| Rate for Payer: Healthscope Whirlpool |
$359.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$333.43
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.73
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$258.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.02
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$370.48
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$259.34 |
| Max. Negotiated Rate |
$370.48 |
| Rate for Payer: Aetna Commercial |
$333.43
|
| Rate for Payer: ASR ASR |
$359.37
|
| Rate for Payer: BCBS Trust/PPO |
$287.23
|
| Rate for Payer: BCN Commercial |
$287.23
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$348.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Healthscope Commercial |
$370.48
|
| Rate for Payer: Healthscope Whirlpool |
$359.37
|
| Rate for Payer: Mclaren Commercial |
$333.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.02
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$745.32 |
| Max. Negotiated Rate |
$1,064.75 |
| Rate for Payer: Aetna Commercial |
$958.28
|
| Rate for Payer: ASR ASR |
$1,032.81
|
| Rate for Payer: BCBS Trust/PPO |
$825.50
|
| Rate for Payer: BCN Commercial |
$825.50
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$1,000.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.80
|
| Rate for Payer: Healthscope Commercial |
$1,064.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.81
|
| Rate for Payer: Mclaren Commercial |
$958.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.98
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,064.75 |
| Rate for Payer: Aetna Commercial |
$958.28
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,032.81
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$825.50
|
| Rate for Payer: BCN Commercial |
$825.50
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$1,000.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,064.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$958.28
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.04
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.95
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$233.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.98
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: ASR ASR |
$277.03
|
| Rate for Payer: BCBS Trust/PPO |
$221.43
|
| Rate for Payer: BCN Commercial |
$221.43
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Healthscope Commercial |
$285.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.03
|
| Rate for Payer: Mclaren Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.33
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$277.03
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$221.43
|
| Rate for Payer: BCN Commercial |
$221.43
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$285.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$257.04
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.90
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$202.78
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.33
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$750.70 |
| Rate for Payer: Aetna Commercial |
$675.63
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$728.18
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$582.02
|
| Rate for Payer: BCN Commercial |
$582.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$705.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$750.70
|
| Rate for Payer: Healthscope Whirlpool |
$728.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$675.63
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.61
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$301.29
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.62
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.49 |
| Max. Negotiated Rate |
$750.70 |
| Rate for Payer: Aetna Commercial |
$675.63
|
| Rate for Payer: ASR ASR |
$728.18
|
| Rate for Payer: BCBS Trust/PPO |
$582.02
|
| Rate for Payer: BCN Commercial |
$582.02
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$705.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Healthscope Commercial |
$750.70
|
| Rate for Payer: Healthscope Whirlpool |
$728.18
|
| Rate for Payer: Mclaren Commercial |
$675.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.62
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.49 |
| Max. Negotiated Rate |
$750.70 |
| Rate for Payer: Aetna Commercial |
$675.63
|
| Rate for Payer: ASR ASR |
$728.18
|
| Rate for Payer: BCBS Trust/PPO |
$582.02
|
| Rate for Payer: BCN Commercial |
$582.02
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$705.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Healthscope Commercial |
$750.70
|
| Rate for Payer: Healthscope Whirlpool |
$728.18
|
| Rate for Payer: Mclaren Commercial |
$675.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.62
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$750.70 |
| Rate for Payer: Aetna Commercial |
$675.63
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$728.18
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$582.02
|
| Rate for Payer: BCN Commercial |
$582.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$705.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$750.70
|
| Rate for Payer: Healthscope Whirlpool |
$728.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$675.63
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$255.72
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.62
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$700.61 |
| Rate for Payer: Aetna Commercial |
$630.55
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$679.59
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$543.18
|
| Rate for Payer: BCN Commercial |
$543.18
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$658.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$700.61
|
| Rate for Payer: Healthscope Whirlpool |
$679.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$630.55
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.52
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$175.27
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.54
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$700.61 |
| Rate for Payer: Aetna Commercial |
$630.55
|
| Rate for Payer: ASR ASR |
$679.59
|
| Rate for Payer: BCBS Trust/PPO |
$543.18
|
| Rate for Payer: BCN Commercial |
$543.18
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$658.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.49
|
| Rate for Payer: Healthscope Commercial |
$700.61
|
| Rate for Payer: Healthscope Whirlpool |
$679.59
|
| Rate for Payer: Mclaren Commercial |
$630.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.54
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: ASR ASR |
$16.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.84
|
| Rate for Payer: BCN Commercial |
$12.84
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$15.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$16.56
|
| Rate for Payer: Healthscope Whirlpool |
$16.06
|
| Rate for Payer: Mclaren Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.07
|
| Rate for Payer: Priority Health Narrow Network |
$11.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.57
|
|
