|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,821.57 |
| Max. Negotiated Rate |
$12,568.39 |
| Rate for Payer: Aetna Commercial |
$3,906.78
|
| Rate for Payer: Aetna Medicare |
$8,108.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: ASR ASR |
$4,210.64
|
| Rate for Payer: ASR Commercial |
$4,210.64
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,554.74
|
| Rate for Payer: BCN Commercial |
$3,365.48
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$4,080.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Healthscope Commercial |
$4,340.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,210.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,108.64
|
| Rate for Payer: Mclaren Commercial |
$3,906.78
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: Nomi Health Commercial |
$3,559.51
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Commercial |
$8,919.50
|
| Rate for Payer: PHP Medicaid |
$4,346.23
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,803.47
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$3,042.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,819.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$12,568.39
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP DNSP |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,346.23
|
| Rate for Payer: VA VA |
$8,108.64
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$452.01 |
| Rate for Payer: Aetna Commercial |
$406.81
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: ASR ASR |
$438.45
|
| Rate for Payer: ASR Commercial |
$438.45
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS Trust/PPO |
$370.15
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$424.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$452.01
|
| Rate for Payer: Healthscope Whirlpool |
$438.45
|
| Rate for Payer: Mclaren Commercial |
$406.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.11
|
| Rate for Payer: Priority Health Narrow Network |
$260.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.77
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$452.01 |
| Rate for Payer: Aetna Commercial |
$406.81
|
| Rate for Payer: ASR ASR |
$438.45
|
| Rate for Payer: ASR Commercial |
$438.45
|
| Rate for Payer: BCBS Trust/PPO |
$368.34
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$424.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$452.01
|
| Rate for Payer: Healthscope Whirlpool |
$438.45
|
| Rate for Payer: Mclaren Commercial |
$406.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.77
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: ASR Commercial |
$83.11
|
| Rate for Payer: BCBS Trust/PPO |
$69.82
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
HC SITZ MARKER
|
Facility
|
OP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: ASR Commercial |
$83.11
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: BCBS Trust/PPO |
$70.16
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,571.76 |
| Max. Negotiated Rate |
$5,495.01 |
| Rate for Payer: Aetna Commercial |
$4,945.51
|
| Rate for Payer: ASR ASR |
$5,330.16
|
| Rate for Payer: ASR Commercial |
$5,330.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,477.88
|
| Rate for Payer: BCN Commercial |
$4,260.28
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$5,165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Healthscope Commercial |
$5,495.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,330.16
|
| Rate for Payer: Mclaren Commercial |
$4,945.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: Nomi Health Commercial |
$4,505.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,835.61
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$5,495.01 |
| Rate for Payer: Aetna Commercial |
$4,945.51
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$5,330.16
|
| Rate for Payer: ASR Commercial |
$5,330.16
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,499.86
|
| Rate for Payer: BCN Commercial |
$4,260.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$5,165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$5,495.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,330.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$4,945.51
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: Nomi Health Commercial |
$4,505.91
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,814.73
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$3,852.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,835.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Trust/PPO |
$222.22
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$256.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$223.31
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$256.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.84
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$141.47
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
OP
|
$18.73
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$263.43 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.17
|
| Rate for Payer: ASR Commercial |
$18.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Commercial |
$14.52
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Healthscope Whirlpool |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: Nomi Health Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.43
|
| Rate for Payer: Priority Health Narrow Network |
$210.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.48
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
IP
|
$18.73
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: ASR ASR |
$18.17
|
| Rate for Payer: ASR Commercial |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$15.26
|
| Rate for Payer: BCN Commercial |
$14.52
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Healthscope Whirlpool |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: Nomi Health Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.48
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,764.69
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.00
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$2,488.22
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,422.42
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
IP
|
$2,764.69
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,797.05 |
| Max. Negotiated Rate |
$2,764.69 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,252.95
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Mclaren Commercial |
$2,488.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.01
|
| Rate for Payer: Mclaren Medicare |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: Meridian Medicaid |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: PACE Medicare |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicaid |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.01
|
| Rate for Payer: VA VA |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.01
|
| Rate for Payer: Mclaren Medicare |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: Meridian Medicaid |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: PACE Medicare |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicaid |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.01
|
| Rate for Payer: VA VA |
$0.01
|
|
|
HC SMART NEEDLE
|
Facility
|
OP
|
$500.32
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$200.13 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: Aetna Medicare |
$250.16
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Complete |
$200.13
|
| Rate for Payer: BCBS Trust/PPO |
$409.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.38
|
| Rate for Payer: Priority Health Narrow Network |
$350.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
|
|
HC SMART NEEDLE
|
Facility
|
IP
|
$500.32
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$325.21 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Trust/PPO |
$407.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$153.73 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$122.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$122.76 |
| Rate for Payer: Aetna Commercial |
$110.48
|
| Rate for Payer: Aetna Medicare |
$29.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.49
|
| Rate for Payer: ASR ASR |
$119.08
|
| Rate for Payer: ASR Commercial |
$119.08
|
| Rate for Payer: BCBS Complete |
$16.43
|
| Rate for Payer: BCBS MAPPO |
$29.19
|
| Rate for Payer: BCBS Trust/PPO |
$100.53
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.19
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cofinity Commercial |
$115.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$122.76
|
| Rate for Payer: Healthscope Whirlpool |
$119.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.19
|
| Rate for Payer: Mclaren Commercial |
$110.48
|
| Rate for Payer: Mclaren Medicaid |
$15.65
|
| Rate for Payer: Mclaren Medicare |
$29.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.65
|
| Rate for Payer: Meridian Medicaid |
$16.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.66
|
| Rate for Payer: PACE Medicare |
$27.73
|
| Rate for Payer: PACE SWMI |
$29.19
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: PHP Medicaid |
$15.65
|
| Rate for Payer: PHP Medicare Advantage |
$29.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.88
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: Priority Health Narrow Network |
$52.70
|
| Rate for Payer: Railroad Medicare Medicare |
$29.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.19
|
| Rate for Payer: UHC Exchange |
$45.24
|
| Rate for Payer: UHC Medicare Advantage |
$29.19
|
| Rate for Payer: UHCCP DNSP |
$29.19
|
| Rate for Payer: UHCCP Medicaid |
$15.65
|
| Rate for Payer: VA VA |
$29.19
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
IP
|
$122.76
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$122.76 |
| Rate for Payer: Aetna Commercial |
$110.48
|
| Rate for Payer: ASR ASR |
$119.08
|
| Rate for Payer: ASR Commercial |
$119.08
|
| Rate for Payer: BCBS Trust/PPO |
$100.04
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cofinity Commercial |
$115.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.21
|
| Rate for Payer: Healthscope Commercial |
$122.76
|
| Rate for Payer: Healthscope Whirlpool |
$119.08
|
| Rate for Payer: Mclaren Commercial |
$110.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.03
|
|
