|
HC REMOVE FOREIGN BODY COMPLIC
|
Facility
|
IP
|
$2,184.69
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
76100225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,638.52 |
| Max. Negotiated Rate |
$2,184.69 |
| Rate for Payer: Aetna Commercial |
$1,966.22
|
| Rate for Payer: ASR ASR |
$2,119.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,794.07
|
| Rate for Payer: BCN Commercial |
$1,794.07
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cofinity Commercial |
$2,053.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.75
|
| Rate for Payer: Healthscope Commercial |
$2,119.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,184.69
|
| Rate for Payer: Mclaren Commercial |
$1,966.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.99
|
| Rate for Payer: Nomi Health Commercial |
$1,791.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,922.53
|
|
|
HC REMOVE FOREIGN BODY COMPLIC
|
Facility
|
OP
|
$2,184.69
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
76100225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$3,014.28 |
| Rate for Payer: Aetna Commercial |
$1,966.22
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$2,119.15
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.28
|
| Rate for Payer: BCN Commercial |
$1,801.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cofinity Commercial |
$2,053.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,119.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,184.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$1,966.22
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.99
|
| Rate for Payer: Nomi Health Commercial |
$1,791.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.52
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,014.28
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,411.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,922.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC REMOVE FOREIGN BODY EYE EXTERNAL
|
Facility
|
IP
|
$116.12
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
45000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$104.51
|
| Rate for Payer: ASR ASR |
$112.64
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$95.36
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cofinity Commercial |
$109.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.90
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Healthscope Whirlpool |
$116.12
|
| Rate for Payer: Mclaren Commercial |
$104.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.70
|
| Rate for Payer: Nomi Health Commercial |
$95.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.19
|
|
|
HC REMOVE FOREIGN BODY EYE EXTERNAL
|
Facility
|
OP
|
$116.12
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
45000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$207.30 |
| Rate for Payer: Aetna Commercial |
$104.51
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$112.64
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$95.74
|
| Rate for Payer: BCN Commercial |
$95.74
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cofinity Commercial |
$109.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Healthscope Whirlpool |
$116.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$104.51
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.70
|
| Rate for Payer: Nomi Health Commercial |
$95.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.09
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$207.30
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$165.84
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC REMOVE INT URETERAL STENT
|
Facility
|
IP
|
$2,832.85
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
36100237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,124.64 |
| Max. Negotiated Rate |
$2,832.85 |
| Rate for Payer: Aetna Commercial |
$2,549.57
|
| Rate for Payer: ASR ASR |
$2,747.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,326.34
|
| Rate for Payer: BCN Commercial |
$2,326.34
|
| Rate for Payer: Cash Price |
$2,266.28
|
| Rate for Payer: Cofinity Commercial |
$2,662.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.28
|
| Rate for Payer: Healthscope Commercial |
$2,747.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,832.85
|
| Rate for Payer: Mclaren Commercial |
$2,549.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.92
|
| Rate for Payer: Nomi Health Commercial |
$2,322.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.91
|
|
|
HC REMOVE INT URETERAL STENT
|
Facility
|
OP
|
$2,832.85
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
36100237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$2,549.57
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$2,747.86
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.68
|
| Rate for Payer: BCN Commercial |
$2,335.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,266.28
|
| Rate for Payer: Cash Price |
$2,266.28
|
| Rate for Payer: Cofinity Commercial |
$2,662.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,747.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,832.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$2,549.57
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.92
|
| Rate for Payer: Nomi Health Commercial |
$2,322.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.64
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,482.14
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,985.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC REMOVE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
OP
|
$990.91
|
|
|
Service Code
|
CPT 50386
|
| Hospital Charge Code |
36100239
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$694.63 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$891.82
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$961.18
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$817.01
|
| Rate for Payer: BCN Commercial |
$817.01
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$792.73
|
| Rate for Payer: Cash Price |
$792.73
|
| Rate for Payer: Cofinity Commercial |
$931.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$961.18
|
| Rate for Payer: Healthscope Whirlpool |
$990.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$891.82
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.27
|
| Rate for Payer: Nomi Health Commercial |
$812.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.18
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$868.24
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$694.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC REMOVE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
IP
|
$990.91
|
|
|
Service Code
|
CPT 50386
|
| Hospital Charge Code |
36100239
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$743.18 |
| Max. Negotiated Rate |
$990.91 |
| Rate for Payer: Aetna Commercial |
$891.82
|
| Rate for Payer: ASR ASR |
$961.18
|
| Rate for Payer: BCBS Trust/PPO |
$813.74
|
| Rate for Payer: BCN Commercial |
$813.74
|
| Rate for Payer: Cash Price |
$792.73
|
| Rate for Payer: Cofinity Commercial |
$931.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.73
|
| Rate for Payer: Healthscope Commercial |
$961.18
|
| Rate for Payer: Healthscope Whirlpool |
$990.91
|
| Rate for Payer: Mclaren Commercial |
$891.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.27
|
| Rate for Payer: Nomi Health Commercial |
$812.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.00
|
|
|
HC REMOVE NEPHROSTOMY TUBE
|
Facility
|
IP
|
$943.15
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
36100241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$707.36 |
| Max. Negotiated Rate |
$943.15 |
| Rate for Payer: Aetna Commercial |
$848.84
|
| Rate for Payer: ASR ASR |
$914.86
|
| Rate for Payer: BCBS Trust/PPO |
$774.51
|
| Rate for Payer: BCN Commercial |
$774.51
|
| Rate for Payer: Cash Price |
$754.52
|
| Rate for Payer: Cofinity Commercial |
$886.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.52
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Healthscope Whirlpool |
$943.15
|
| Rate for Payer: Mclaren Commercial |
$848.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.68
|
| Rate for Payer: Nomi Health Commercial |
$773.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.97
|
|
|
HC REMOVE NEPHROSTOMY TUBE
|
Facility
|
OP
|
$943.15
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
36100241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$1,076.92 |
| Rate for Payer: Aetna Commercial |
$848.84
|
| Rate for Payer: Aetna Medicare |
$694.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: ASR ASR |
$914.86
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$777.63
|
| Rate for Payer: BCN Commercial |
$777.63
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$754.52
|
| Rate for Payer: Cash Price |
$754.52
|
| Rate for Payer: Cofinity Commercial |
$886.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Healthscope Whirlpool |
$943.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$694.79
|
| Rate for Payer: Mclaren Commercial |
$848.84
|
| Rate for Payer: Mclaren Medicaid |
$694.79
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$381.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.68
|
| Rate for Payer: Nomi Health Commercial |
$773.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.36
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$764.27
|
| Rate for Payer: PHP Medicaid |
$372.41
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$826.39
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health Narrow Network |
$661.15
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$1,076.92
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP DNSP |
$694.79
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC REMOVE REPLACE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
OP
|
$2,967.49
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
36100238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$2,670.74
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$2,878.47
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,446.70
|
| Rate for Payer: BCN Commercial |
$2,446.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,373.99
|
| Rate for Payer: Cash Price |
$2,373.99
|
| Rate for Payer: Cofinity Commercial |
$2,789.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,373.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,878.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,967.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$2,670.74
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,522.37
|
| Rate for Payer: Nomi Health Commercial |
$2,433.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,225.62
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,600.11
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,080.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,611.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC REMOVE REPLACE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
IP
|
$2,967.49
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
36100238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,225.62 |
| Max. Negotiated Rate |
$2,967.49 |
| Rate for Payer: Aetna Commercial |
$2,670.74
|
| Rate for Payer: ASR ASR |
$2,878.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,436.90
|
| Rate for Payer: BCN Commercial |
$2,436.90
|
| Rate for Payer: Cash Price |
$2,373.99
|
| Rate for Payer: Cofinity Commercial |
$2,789.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,373.99
|
| Rate for Payer: Healthscope Commercial |
$2,878.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,967.49
|
| Rate for Payer: Mclaren Commercial |
$2,670.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,522.37
|
| Rate for Payer: Nomi Health Commercial |
$2,433.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,225.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,611.39
|
|
|
HC REMOVE & REPLACE SUBSTERN IMPLANT DEFIB PG
|
Facility
|
OP
|
$50,503.93
|
|
|
Service Code
|
CPT 0614T
|
| Hospital Charge Code |
48100135
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,591.56 |
| Max. Negotiated Rate |
$50,503.93 |
| Rate for Payer: Aetna Commercial |
$45,453.54
|
| Rate for Payer: Aetna Medicare |
$22,163.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,704.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,704.49
|
| Rate for Payer: ASR ASR |
$48,988.81
|
| Rate for Payer: BCBS Complete |
$12,172.24
|
| Rate for Payer: BCBS MAPPO |
$22,163.59
|
| Rate for Payer: BCBS Trust/PPO |
$41,640.49
|
| Rate for Payer: BCN Commercial |
$41,640.49
|
| Rate for Payer: BCN Medicare Advantage |
$22,163.59
|
| Rate for Payer: Cash Price |
$40,403.14
|
| Rate for Payer: Cash Price |
$40,403.14
|
| Rate for Payer: Cofinity Commercial |
$47,473.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,403.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,163.59
|
| Rate for Payer: Healthscope Commercial |
$48,988.81
|
| Rate for Payer: Healthscope Whirlpool |
$50,503.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,163.59
|
| Rate for Payer: Mclaren Commercial |
$45,453.54
|
| Rate for Payer: Mclaren Medicaid |
$22,163.59
|
| Rate for Payer: Mclaren Medicare |
$22,163.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,271.77
|
| Rate for Payer: Meridian Medicaid |
$12,172.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,488.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,379.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,928.34
|
| Rate for Payer: Nomi Health Commercial |
$41,413.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,877.95
|
| Rate for Payer: PACE Medicare |
$21,055.41
|
| Rate for Payer: PACE SWMI |
$22,163.59
|
| Rate for Payer: PHP Commercial |
$24,379.95
|
| Rate for Payer: PHP Medicaid |
$11,879.68
|
| Rate for Payer: PHP Medicare Advantage |
$22,163.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,591.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,251.54
|
| Rate for Payer: Priority Health Medicare |
$22,163.59
|
| Rate for Payer: Priority Health Narrow Network |
$35,403.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22,163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,443.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,163.59
|
| Rate for Payer: UHC Exchange |
$34,353.56
|
| Rate for Payer: UHC Medicaid |
$11,591.56
|
| Rate for Payer: UHCCP DNSP |
$22,163.59
|
| Rate for Payer: UHCCP Medicaid |
$11,591.56
|
| Rate for Payer: VA VA |
$22,163.59
|
|
|
HC REMOVE & REPLACE SUBSTERN IMPLANT DEFIB PG
|
Facility
|
IP
|
$50,503.93
|
|
|
Service Code
|
CPT 0614T
|
| Hospital Charge Code |
48100135
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$37,877.95 |
| Max. Negotiated Rate |
$50,503.93 |
| Rate for Payer: Aetna Commercial |
$45,453.54
|
| Rate for Payer: ASR ASR |
$48,988.81
|
| Rate for Payer: BCBS Trust/PPO |
$41,473.83
|
| Rate for Payer: BCN Commercial |
$41,473.83
|
| Rate for Payer: Cash Price |
$40,403.14
|
| Rate for Payer: Cofinity Commercial |
$47,473.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,403.14
|
| Rate for Payer: Healthscope Commercial |
$48,988.81
|
| Rate for Payer: Healthscope Whirlpool |
$50,503.93
|
| Rate for Payer: Mclaren Commercial |
$45,453.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,928.34
|
| Rate for Payer: Nomi Health Commercial |
$41,413.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,877.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,443.46
|
|
|
HC REMOVE SESAMOID BONE 1ST TOE
|
Facility
|
IP
|
$8,531.28
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,398.46 |
| Max. Negotiated Rate |
$8,531.28 |
| Rate for Payer: Aetna Commercial |
$7,678.15
|
| Rate for Payer: ASR ASR |
$8,275.34
|
| Rate for Payer: BCBS Trust/PPO |
$7,005.89
|
| Rate for Payer: BCN Commercial |
$7,005.89
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Commercial |
$8,019.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Healthscope Commercial |
$8,275.34
|
| Rate for Payer: Healthscope Whirlpool |
$8,531.28
|
| Rate for Payer: Mclaren Commercial |
$7,678.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Nomi Health Commercial |
$6,995.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,507.53
|
|
|
HC REMOVE SESAMOID BONE 1ST TOE
|
Facility
|
OP
|
$8,531.28
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$8,531.28 |
| Rate for Payer: Aetna Commercial |
$7,678.15
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$8,275.34
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,034.04
|
| Rate for Payer: BCN Commercial |
$7,034.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Commercial |
$8,019.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$8,275.34
|
| Rate for Payer: Healthscope Whirlpool |
$8,531.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$7,678.15
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Nomi Health Commercial |
$6,995.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,475.11
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$5,980.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,507.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$5,053.36
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC REMOVE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$4,654.45
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36100611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$4,654.45 |
| Rate for Payer: Aetna Commercial |
$4,189.01
|
| Rate for Payer: Aetna Medicare |
$1,945.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: ASR ASR |
$4,514.82
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,837.59
|
| Rate for Payer: BCN Commercial |
$3,837.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Cash Price |
$3,723.56
|
| Rate for Payer: Cash Price |
$3,723.56
|
| Rate for Payer: Cofinity Commercial |
$4,375.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,723.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Healthscope Commercial |
$4,514.82
|
| Rate for Payer: Healthscope Whirlpool |
$4,654.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,945.70
|
| Rate for Payer: Mclaren Commercial |
$4,189.01
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$1,068.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,956.28
|
| Rate for Payer: Nomi Health Commercial |
$3,816.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,490.84
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Commercial |
$2,140.27
|
| Rate for Payer: PHP Medicaid |
$1,042.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,078.23
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Narrow Network |
$3,262.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,095.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Exchange |
$3,015.84
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP DNSP |
$1,945.70
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
HC REMOVE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$4,654.45
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36100611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,490.84 |
| Max. Negotiated Rate |
$4,654.45 |
| Rate for Payer: Aetna Commercial |
$4,189.01
|
| Rate for Payer: ASR ASR |
$4,514.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,822.23
|
| Rate for Payer: BCN Commercial |
$3,822.23
|
| Rate for Payer: Cash Price |
$3,723.56
|
| Rate for Payer: Cofinity Commercial |
$4,375.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,723.56
|
| Rate for Payer: Healthscope Commercial |
$4,514.82
|
| Rate for Payer: Healthscope Whirlpool |
$4,654.45
|
| Rate for Payer: Mclaren Commercial |
$4,189.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,956.28
|
| Rate for Payer: Nomi Health Commercial |
$3,816.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,490.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,095.92
|
|
|
HC REMOVE SUTURES AND STAPLES NO ANES
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
76100371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: BCBS Complete |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$37.75
|
| Rate for Payer: BCN Commercial |
$37.75
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Healthscope Whirlpool |
$45.78
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.11
|
| Rate for Payer: Priority Health Narrow Network |
$32.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC REMOVE SUTURES AND STAPLES NO ANES
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
76100371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.59
|
| Rate for Payer: BCN Commercial |
$37.59
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Healthscope Whirlpool |
$45.78
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC REMOVE SUTURES OR STAPLES NO ANES
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.48
|
| Rate for Payer: BCN Commercial |
$26.48
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC REMOVE SUTURES OR STAPLES NO ANES
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$26.59
|
| Rate for Payer: BCN Commercial |
$26.59
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.26
|
| Rate for Payer: Priority Health Narrow Network |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC REMOVE SUTURES OR STAPLES REQ ANES
|
Facility
|
IP
|
$5,207.19
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,905.39 |
| Max. Negotiated Rate |
$5,207.19 |
| Rate for Payer: Aetna Commercial |
$4,686.47
|
| Rate for Payer: ASR ASR |
$5,050.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,276.14
|
| Rate for Payer: BCN Commercial |
$4,276.14
|
| Rate for Payer: Cash Price |
$4,165.75
|
| Rate for Payer: Cofinity Commercial |
$4,894.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,165.75
|
| Rate for Payer: Healthscope Commercial |
$5,050.97
|
| Rate for Payer: Healthscope Whirlpool |
$5,207.19
|
| Rate for Payer: Mclaren Commercial |
$4,686.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,426.11
|
| Rate for Payer: Nomi Health Commercial |
$4,269.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,905.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,582.33
|
|
|
HC REMOVE SUTURES OR STAPLES REQ ANES
|
Facility
|
OP
|
$5,207.19
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$5,207.19 |
| Rate for Payer: Aetna Commercial |
$4,686.47
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$5,050.97
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,293.33
|
| Rate for Payer: BCN Commercial |
$4,293.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$4,165.75
|
| Rate for Payer: Cash Price |
$4,165.75
|
| Rate for Payer: Cofinity Commercial |
$4,894.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,165.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$5,050.97
|
| Rate for Payer: Healthscope Whirlpool |
$5,207.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$4,686.47
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,426.11
|
| Rate for Payer: Nomi Health Commercial |
$4,269.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,905.39
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,562.54
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,650.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,582.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
30100016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$36.08 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: ASR ASR |
$35.00
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.08
|
| Rate for Payer: Mclaren Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$29.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.75
|
|
