|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$377.89 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$366.55
|
| Rate for Payer: ASR Commercial |
$366.55
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$309.45
|
| Rate for Payer: BCN Commercial |
$292.98
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$355.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$377.89
|
| Rate for Payer: Healthscope Whirlpool |
$366.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$340.10
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.32
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$276.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$377.89 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: ASR ASR |
$366.55
|
| Rate for Payer: ASR Commercial |
$366.55
|
| Rate for Payer: BCBS Trust/PPO |
$307.94
|
| Rate for Payer: BCN Commercial |
$292.98
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$355.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$377.89
|
| Rate for Payer: Healthscope Whirlpool |
$366.55
|
| Rate for Payer: Mclaren Commercial |
$340.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.54
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$705.93 |
| Max. Negotiated Rate |
$1,086.05 |
| Rate for Payer: Aetna Commercial |
$977.44
|
| Rate for Payer: ASR ASR |
$1,053.47
|
| Rate for Payer: ASR Commercial |
$1,053.47
|
| Rate for Payer: BCBS Trust/PPO |
$885.02
|
| Rate for Payer: BCN Commercial |
$842.01
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$1,020.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Healthscope Commercial |
$1,086.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,053.47
|
| Rate for Payer: Mclaren Commercial |
$977.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: Nomi Health Commercial |
$890.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.72
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,086.05 |
| Rate for Payer: Aetna Commercial |
$977.44
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,053.47
|
| Rate for Payer: ASR Commercial |
$1,053.47
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$889.37
|
| Rate for Payer: BCN Commercial |
$842.01
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$1,020.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,086.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,053.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$977.44
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: Nomi Health Commercial |
$890.56
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.39
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$249.91
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$291.31 |
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: ASR ASR |
$282.57
|
| Rate for Payer: ASR Commercial |
$282.57
|
| Rate for Payer: BCBS Trust/PPO |
$237.39
|
| Rate for Payer: BCN Commercial |
$225.85
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$273.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Healthscope Commercial |
$291.31
|
| Rate for Payer: Healthscope Whirlpool |
$282.57
|
| Rate for Payer: Mclaren Commercial |
$262.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: Nomi Health Commercial |
$238.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.35
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$291.31 |
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$282.57
|
| Rate for Payer: ASR Commercial |
$282.57
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$238.55
|
| Rate for Payer: BCN Commercial |
$225.85
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$273.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$291.31
|
| Rate for Payer: Healthscope Whirlpool |
$282.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$262.18
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: Nomi Health Commercial |
$238.87
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.25
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$204.21
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$497.71 |
| Max. Negotiated Rate |
$765.71 |
| Rate for Payer: Aetna Commercial |
$689.14
|
| Rate for Payer: ASR ASR |
$742.74
|
| Rate for Payer: ASR Commercial |
$742.74
|
| Rate for Payer: BCBS Trust/PPO |
$623.98
|
| Rate for Payer: BCN Commercial |
$593.65
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$719.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$765.71
|
| Rate for Payer: Healthscope Whirlpool |
$742.74
|
| Rate for Payer: Mclaren Commercial |
$689.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.82
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$765.71 |
| Rate for Payer: Aetna Commercial |
$689.14
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$742.74
|
| Rate for Payer: ASR Commercial |
$742.74
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$627.04
|
| Rate for Payer: BCN Commercial |
$593.65
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$719.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$765.71
|
| Rate for Payer: Healthscope Whirlpool |
$742.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$689.14
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.97
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$322.38
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$497.71 |
| Max. Negotiated Rate |
$765.71 |
| Rate for Payer: Aetna Commercial |
$689.14
|
| Rate for Payer: ASR ASR |
$742.74
|
| Rate for Payer: ASR Commercial |
$742.74
|
| Rate for Payer: BCBS Trust/PPO |
$623.98
|
| Rate for Payer: BCN Commercial |
$593.65
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$719.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$765.71
|
| Rate for Payer: Healthscope Whirlpool |
$742.74
|
| Rate for Payer: Mclaren Commercial |
$689.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.82
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$765.71 |
| Rate for Payer: Aetna Commercial |
$689.14
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$742.74
|
| Rate for Payer: ASR Commercial |
$742.74
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$627.04
|
| Rate for Payer: BCN Commercial |
$593.65
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$719.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$765.71
|
| Rate for Payer: Healthscope Whirlpool |
$742.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$689.14
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.03
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$273.62
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$714.62 |
| Rate for Payer: Aetna Commercial |
$643.16
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$693.18
|
| Rate for Payer: ASR Commercial |
$693.18
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$585.20
|
| Rate for Payer: BCN Commercial |
$554.04
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$671.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$714.62
|
| Rate for Payer: Healthscope Whirlpool |
$693.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$643.16
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: Nomi Health Commercial |
$585.99
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.43
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$187.54
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$464.50 |
| Max. Negotiated Rate |
$714.62 |
| Rate for Payer: Aetna Commercial |
$643.16
|
| Rate for Payer: ASR ASR |
$693.18
|
| Rate for Payer: ASR Commercial |
$693.18
|
| Rate for Payer: BCBS Trust/PPO |
$582.34
|
| Rate for Payer: BCN Commercial |
$554.04
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$671.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Healthscope Commercial |
$714.62
|
| Rate for Payer: Healthscope Whirlpool |
$693.18
|
| Rate for Payer: Mclaren Commercial |
$643.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: Nomi Health Commercial |
$585.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.87
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: ASR ASR |
$16.38
|
| Rate for Payer: ASR Commercial |
$16.38
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$16.89
|
| Rate for Payer: Healthscope Whirlpool |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.80
|
| Rate for Payer: Priority Health Narrow Network |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.86
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: ASR ASR |
$16.38
|
| Rate for Payer: ASR Commercial |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$13.76
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$16.89
|
| Rate for Payer: Healthscope Whirlpool |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.86
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$785.96 |
| Rate for Payer: Aetna Commercial |
$707.36
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$762.38
|
| Rate for Payer: ASR Commercial |
$762.38
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$643.62
|
| Rate for Payer: BCN Commercial |
$609.35
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$738.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$785.96
|
| Rate for Payer: Healthscope Whirlpool |
$762.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$707.36
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: Nomi Health Commercial |
$644.49
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.19
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$270.55
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$510.87 |
| Max. Negotiated Rate |
$785.96 |
| Rate for Payer: Aetna Commercial |
$707.36
|
| Rate for Payer: ASR ASR |
$762.38
|
| Rate for Payer: ASR Commercial |
$762.38
|
| Rate for Payer: BCBS Trust/PPO |
$640.48
|
| Rate for Payer: BCN Commercial |
$609.35
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$738.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Healthscope Commercial |
$785.96
|
| Rate for Payer: Healthscope Whirlpool |
$762.38
|
| Rate for Payer: Mclaren Commercial |
$707.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: Nomi Health Commercial |
$644.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.64
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$397.99
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.77
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$253.42
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Trust/PPO |
$396.04
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.27 |
| Max. Negotiated Rate |
$680.42 |
| Rate for Payer: Aetna Commercial |
$612.38
|
| Rate for Payer: ASR ASR |
$660.01
|
| Rate for Payer: ASR Commercial |
$660.01
|
| Rate for Payer: BCBS Trust/PPO |
$554.47
|
| Rate for Payer: BCN Commercial |
$527.53
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$639.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Healthscope Commercial |
$680.42
|
| Rate for Payer: Healthscope Whirlpool |
$660.01
|
| Rate for Payer: Mclaren Commercial |
$612.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: Nomi Health Commercial |
$557.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.77
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.17 |
| Max. Negotiated Rate |
$680.42 |
| Rate for Payer: Aetna Commercial |
$612.38
|
| Rate for Payer: Aetna Medicare |
$340.21
|
| Rate for Payer: ASR ASR |
$660.01
|
| Rate for Payer: ASR Commercial |
$660.01
|
| Rate for Payer: BCBS Complete |
$272.17
|
| Rate for Payer: BCBS Trust/PPO |
$557.20
|
| Rate for Payer: BCN Commercial |
$527.53
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$639.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Healthscope Commercial |
$680.42
|
| Rate for Payer: Healthscope Whirlpool |
$660.01
|
| Rate for Payer: Mclaren Commercial |
$612.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: Nomi Health Commercial |
$557.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.22
|
| Rate for Payer: Priority Health Narrow Network |
$364.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.77
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: ASR ASR |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.49
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| 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 |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$136.15
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| 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 |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| 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 |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$148.72
|
| 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 |
$160.28
|
| Rate for Payer: ASR Commercial |
$160.28
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$135.32
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$155.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Healthscope Whirlpool |
$160.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$148.72
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| 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 |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: Nomi Health Commercial |
$135.50
|
| 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 |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.41 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$148.72
|
| Rate for Payer: ASR ASR |
$160.28
|
| Rate for Payer: ASR Commercial |
$160.28
|
| Rate for Payer: BCBS Trust/PPO |
$134.65
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$155.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Healthscope Whirlpool |
$160.28
|
| Rate for Payer: Mclaren Commercial |
$148.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: Nomi Health Commercial |
$135.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.41
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| Rate for Payer: ASR ASR |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Trust/PPO |
$415.92
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
|
