|
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 |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$223.31
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.93
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$191.16
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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 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 |
$18.73 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| 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: 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 |
$16.41
|
| Rate for Payer: Priority Health Narrow Network |
$13.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.48
|
|
|
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 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 |
$1,070.86 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.00
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| 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 |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$2,488.22
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,422.42
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC 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 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 & 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
|
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 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 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 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 |
$35.17 |
| 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 |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| 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 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
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$122.76 |
| Rate for Payer: Aetna Commercial |
$110.48
|
| Rate for Payer: Aetna Medicare |
$29.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: ASR ASR |
$119.08
|
| Rate for Payer: ASR Commercial |
$119.08
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$100.53
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| 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 |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$122.76
|
| Rate for Payer: Healthscope Whirlpool |
$119.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$110.48
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.66
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$31.95
|
| Rate for Payer: PHP Medicaid |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.56
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health Narrow Network |
$86.05
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP DNSP |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
IP
|
$122.76
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
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
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$122.76 |
| Rate for Payer: Aetna Commercial |
$110.48
|
| Rate for Payer: Aetna Medicare |
$29.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: ASR ASR |
$119.08
|
| Rate for Payer: ASR Commercial |
$119.08
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$100.53
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| 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 |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$122.76
|
| Rate for Payer: Healthscope Whirlpool |
$119.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$110.48
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.66
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$31.95
|
| Rate for Payer: PHP Medicaid |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.56
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health Narrow Network |
$86.05
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP DNSP |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC SMRNP
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
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 SMRNP
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| 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 |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| 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 SNARE
|
Facility
|
IP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.01 |
| Max. Negotiated Rate |
$1,289.24 |
| Rate for Payer: Aetna Commercial |
$1,160.32
|
| Rate for Payer: ASR ASR |
$1,250.56
|
| Rate for Payer: ASR Commercial |
$1,250.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.60
|
| Rate for Payer: BCN Commercial |
$999.55
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,211.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$1,289.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.56
|
| Rate for Payer: Mclaren Commercial |
$1,160.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,057.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.53
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.70 |
| Max. Negotiated Rate |
$1,289.24 |
| Rate for Payer: Aetna Commercial |
$1,160.32
|
| Rate for Payer: Aetna Medicare |
$644.62
|
| Rate for Payer: ASR ASR |
$1,250.56
|
| Rate for Payer: ASR Commercial |
$1,250.56
|
| Rate for Payer: BCBS Complete |
$515.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.76
|
| Rate for Payer: BCN Commercial |
$999.55
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,211.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$1,289.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.56
|
| Rate for Payer: Mclaren Commercial |
$1,160.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,057.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.63
|
| Rate for Payer: Priority Health Narrow Network |
$903.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.53
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
