|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$702.81 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$843.37
|
| Rate for Payer: ASR ASR |
$908.97
|
| Rate for Payer: BCBS Trust/PPO |
$769.53
|
| Rate for Payer: BCN Commercial |
$769.53
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Healthscope Commercial |
$908.97
|
| Rate for Payer: Healthscope Whirlpool |
$937.08
|
| Rate for Payer: Mclaren Commercial |
$843.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.63
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.09 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Commercial |
$346.90
|
| Rate for Payer: ASR ASR |
$373.89
|
| Rate for Payer: BCBS Trust/PPO |
$316.53
|
| Rate for Payer: BCN Commercial |
$316.53
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Commercial |
$362.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Healthscope Commercial |
$373.89
|
| Rate for Payer: Healthscope Whirlpool |
$385.45
|
| Rate for Payer: Mclaren Commercial |
$346.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Nomi Health Commercial |
$316.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.20
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Commercial |
$346.90
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$373.89
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$317.80
|
| Rate for Payer: BCN Commercial |
$317.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Commercial |
$362.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$373.89
|
| Rate for Payer: Healthscope Whirlpool |
$385.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$346.90
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Nomi Health Commercial |
$316.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$380.72
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$304.58
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,107.77 |
| Rate for Payer: Aetna Commercial |
$996.99
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,074.54
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$913.36
|
| Rate for Payer: BCN Commercial |
$913.36
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Commercial |
$1,041.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,074.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,107.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$996.99
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Nomi Health Commercial |
$908.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$344.41
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$275.53
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$830.83 |
| Max. Negotiated Rate |
$1,107.77 |
| Rate for Payer: Aetna Commercial |
$996.99
|
| Rate for Payer: ASR ASR |
$1,074.54
|
| Rate for Payer: BCBS Trust/PPO |
$909.70
|
| Rate for Payer: BCN Commercial |
$909.70
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Commercial |
$1,041.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Healthscope Commercial |
$1,074.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,107.77
|
| Rate for Payer: Mclaren Commercial |
$996.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Nomi Health Commercial |
$908.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.84
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.85 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$267.43
|
| Rate for Payer: ASR ASR |
$288.23
|
| Rate for Payer: BCBS Trust/PPO |
$244.01
|
| Rate for Payer: BCN Commercial |
$244.01
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$279.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Healthscope Commercial |
$288.23
|
| Rate for Payer: Healthscope Whirlpool |
$297.14
|
| Rate for Payer: Mclaren Commercial |
$267.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Nomi Health Commercial |
$243.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.48
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$267.43
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$288.23
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$244.99
|
| Rate for Payer: BCN Commercial |
$244.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$279.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$288.23
|
| Rate for Payer: Healthscope Whirlpool |
$297.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$267.43
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Nomi Health Commercial |
$243.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$260.35
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$208.30
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$781.02 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$757.59
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$643.95
|
| Rate for Payer: BCN Commercial |
$643.95
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$734.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$757.59
|
| Rate for Payer: Healthscope Whirlpool |
$781.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$702.92
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$444.28
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$355.42
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$687.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$585.76 |
| Max. Negotiated Rate |
$781.02 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: ASR ASR |
$757.59
|
| Rate for Payer: BCBS Trust/PPO |
$641.37
|
| Rate for Payer: BCN Commercial |
$641.37
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$734.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$757.59
|
| Rate for Payer: Healthscope Whirlpool |
$781.02
|
| Rate for Payer: Mclaren Commercial |
$702.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$687.30
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$781.02 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$757.59
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$643.95
|
| Rate for Payer: BCN Commercial |
$643.95
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$734.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$757.59
|
| Rate for Payer: Healthscope Whirlpool |
$781.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$702.92
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$377.09
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$301.67
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$687.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$585.76 |
| Max. Negotiated Rate |
$781.02 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: ASR ASR |
$757.59
|
| Rate for Payer: BCBS Trust/PPO |
$641.37
|
| Rate for Payer: BCN Commercial |
$641.37
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$734.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$757.59
|
| Rate for Payer: Healthscope Whirlpool |
$781.02
|
| Rate for Payer: Mclaren Commercial |
$702.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$687.30
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$728.91 |
| Rate for Payer: Aetna Commercial |
$656.02
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$707.04
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$600.99
|
| Rate for Payer: BCN Commercial |
$600.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Commercial |
$685.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$707.04
|
| Rate for Payer: Healthscope Whirlpool |
$728.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$656.02
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Nomi Health Commercial |
$597.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$258.46
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$206.77
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$641.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$546.68 |
| Max. Negotiated Rate |
$728.91 |
| Rate for Payer: Aetna Commercial |
$656.02
|
| Rate for Payer: ASR ASR |
$707.04
|
| Rate for Payer: BCBS Trust/PPO |
$598.58
|
| Rate for Payer: BCN Commercial |
$598.58
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Commercial |
$685.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Healthscope Commercial |
$707.04
|
| Rate for Payer: Healthscope Whirlpool |
$728.91
|
| Rate for Payer: Mclaren Commercial |
$656.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Nomi Health Commercial |
$597.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$641.44
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: ASR ASR |
$16.71
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Commercial |
$14.21
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$16.71
|
| Rate for Payer: Healthscope Whirlpool |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$15.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.10
|
| Rate for Payer: Priority Health Narrow Network |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.16
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: ASR ASR |
$16.71
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCN Commercial |
$14.15
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$16.71
|
| Rate for Payer: Healthscope Whirlpool |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.16
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.26 |
| Max. Negotiated Rate |
$801.68 |
| Rate for Payer: Aetna Commercial |
$721.51
|
| Rate for Payer: ASR ASR |
$777.63
|
| Rate for Payer: BCBS Trust/PPO |
$658.34
|
| Rate for Payer: BCN Commercial |
$658.34
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Commercial |
$753.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Healthscope Commercial |
$777.63
|
| Rate for Payer: Healthscope Whirlpool |
$801.68
|
| Rate for Payer: Mclaren Commercial |
$721.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Nomi Health Commercial |
$657.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.48
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$801.68 |
| Rate for Payer: Aetna Commercial |
$721.51
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$777.63
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$660.99
|
| Rate for Payer: BCN Commercial |
$660.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Commercial |
$753.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$777.63
|
| Rate for Payer: Healthscope Whirlpool |
$801.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$721.51
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Nomi Health Commercial |
$657.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$372.86
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$298.28
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.79 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Trust/PPO |
$407.09
|
| Rate for Payer: BCN Commercial |
$407.09
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.72
|
| Rate for Payer: BCN Commercial |
$408.72
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$349.24
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$279.39
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$520.52 |
| Max. Negotiated Rate |
$694.03 |
| Rate for Payer: Aetna Commercial |
$624.63
|
| Rate for Payer: ASR ASR |
$673.21
|
| Rate for Payer: BCBS Trust/PPO |
$569.94
|
| Rate for Payer: BCN Commercial |
$569.94
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Commercial |
$652.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Healthscope Commercial |
$673.21
|
| Rate for Payer: Healthscope Whirlpool |
$694.03
|
| Rate for Payer: Mclaren Commercial |
$624.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Nomi Health Commercial |
$569.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$610.75
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$256.79 |
| Max. Negotiated Rate |
$694.03 |
| Rate for Payer: Aetna Commercial |
$624.63
|
| Rate for Payer: Aetna Medicare |
$256.79
|
| Rate for Payer: ASR ASR |
$673.21
|
| Rate for Payer: BCBS Complete |
$277.61
|
| Rate for Payer: BCBS Trust/PPO |
$572.23
|
| Rate for Payer: BCN Commercial |
$572.23
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Commercial |
$652.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Healthscope Commercial |
$673.21
|
| Rate for Payer: Healthscope Whirlpool |
$694.03
|
| Rate for Payer: Mclaren Commercial |
$624.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$555.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Nomi Health Commercial |
$569.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$502.98
|
| Rate for Payer: Priority Health Narrow Network |
$402.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$610.75
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.19 |
| Max. Negotiated Rate |
$169.59 |
| Rate for Payer: Aetna Commercial |
$152.63
|
| Rate for Payer: ASR ASR |
$164.50
|
| Rate for Payer: BCBS Trust/PPO |
$139.27
|
| Rate for Payer: BCN Commercial |
$139.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$169.59
|
| Rate for Payer: Mclaren Commercial |
$152.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.24
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$345.01 |
| Rate for Payer: Aetna Commercial |
$152.63
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$164.50
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$139.83
|
| Rate for Payer: BCN Commercial |
$139.83
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$169.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$152.63
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$276.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$163.48
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$138.96
|
| Rate for Payer: BCN Commercial |
$138.96
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$158.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Healthscope Whirlpool |
$168.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$151.69
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.41 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: ASR ASR |
$163.48
|
| Rate for Payer: BCBS Trust/PPO |
$138.41
|
| Rate for Payer: BCN Commercial |
$138.41
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$158.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Healthscope Whirlpool |
$168.54
|
| Rate for Payer: Mclaren Commercial |
$151.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.32
|
|
