|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$11,938.04
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,775.22 |
| Max. Negotiated Rate |
$11,938.04 |
| Rate for Payer: Aetna Commercial |
$10,744.24
|
| Rate for Payer: ASR ASR |
$11,579.90
|
| Rate for Payer: BCBS Complete |
$4,775.22
|
| Rate for Payer: BCBS Trust/PPO |
$9,255.56
|
| Rate for Payer: BCN Commercial |
$9,255.56
|
| Rate for Payer: Cash Price |
$9,550.43
|
| Rate for Payer: Cofinity Commercial |
$11,221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,550.43
|
| Rate for Payer: Healthscope Commercial |
$11,938.04
|
| Rate for Payer: Healthscope Whirlpool |
$11,579.90
|
| Rate for Payer: Mclaren Commercial |
$10,744.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,147.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,356.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,863.62
|
| Rate for Payer: Priority Health Narrow Network |
$8,476.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,505.48
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$73.47
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$51.43 |
| Max. Negotiated Rate |
$73.47 |
| Rate for Payer: Aetna Commercial |
$66.12
|
| Rate for Payer: ASR ASR |
$71.27
|
| Rate for Payer: BCBS Trust/PPO |
$56.96
|
| Rate for Payer: BCN Commercial |
$56.96
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$69.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$73.47
|
| Rate for Payer: Healthscope Whirlpool |
$71.27
|
| Rate for Payer: Mclaren Commercial |
$66.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.65
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$73.47
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$73.47 |
| Rate for Payer: Aetna Commercial |
$66.12
|
| Rate for Payer: ASR ASR |
$71.27
|
| Rate for Payer: BCBS Complete |
$29.39
|
| Rate for Payer: BCBS Trust/PPO |
$56.96
|
| Rate for Payer: BCN Commercial |
$56.96
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$69.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$73.47
|
| Rate for Payer: Healthscope Whirlpool |
$71.27
|
| Rate for Payer: Mclaren Commercial |
$66.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.86
|
| Rate for Payer: Priority Health Narrow Network |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.65
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$66.79
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$60.11
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.68
|
| Rate for Payer: ASR ASR |
$64.79
|
| Rate for Payer: BCBS Complete |
$12.26
|
| Rate for Payer: BCBS MAPPO |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.78
|
| Rate for Payer: BCN Commercial |
$51.78
|
| Rate for Payer: BCN Medicare Advantage |
$21.34
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.34
|
| Rate for Payer: Healthscope Commercial |
$66.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.34
|
| Rate for Payer: Mclaren Commercial |
$60.11
|
| Rate for Payer: Mclaren Medicaid |
$11.67
|
| Rate for Payer: Mclaren Medicare |
$21.34
|
| Rate for Payer: Meridian Medicaid |
$12.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.77
|
| Rate for Payer: PACE Medicare |
$20.27
|
| Rate for Payer: PACE SWMI |
$21.34
|
| Rate for Payer: PHP Commercial |
$23.47
|
| Rate for Payer: PHP Medicaid |
$11.67
|
| Rate for Payer: PHP Medicare Advantage |
$21.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.06
|
| Rate for Payer: Priority Health Medicare |
$21.34
|
| Rate for Payer: Priority Health Narrow Network |
$64.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.78
|
| Rate for Payer: UHC Medicare Advantage |
$21.98
|
| Rate for Payer: VA VA |
$21.34
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$66.79
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$66.79 |
| Rate for Payer: Aetna Commercial |
$60.11
|
| Rate for Payer: ASR ASR |
$64.79
|
| Rate for Payer: BCBS Trust/PPO |
$51.78
|
| Rate for Payer: BCN Commercial |
$51.78
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Healthscope Commercial |
$66.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.79
|
| Rate for Payer: Mclaren Commercial |
$60.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.78
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.70
|
| Rate for Payer: Priority Health Narrow Network |
$33.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$46.93
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: ASR ASR |
$45.52
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.93
|
| Rate for Payer: Healthscope Whirlpool |
$45.52
|
| Rate for Payer: Mclaren Commercial |
$42.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.71
|
| Rate for Payer: Priority Health Narrow Network |
$33.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.30
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$46.93
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: ASR ASR |
$45.52
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.93
|
| Rate for Payer: Healthscope Whirlpool |
$45.52
|
| Rate for Payer: Mclaren Commercial |
$42.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.30
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$46.93
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: ASR ASR |
$45.52
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.93
|
| Rate for Payer: Healthscope Whirlpool |
$45.52
|
| Rate for Payer: Mclaren Commercial |
$42.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.30
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$46.93
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: ASR ASR |
$45.52
|
| Rate for Payer: BCBS Complete |
$11.72
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$46.93
|
| Rate for Payer: Healthscope Whirlpool |
$45.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.40
|
| Rate for Payer: Mclaren Commercial |
$42.24
|
| Rate for Payer: Mclaren Medicaid |
$11.16
|
| Rate for Payer: Mclaren Medicare |
$20.40
|
| Rate for Payer: Meridian Medicaid |
$11.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PACE Medicare |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$22.44
|
| Rate for Payer: PHP Medicaid |
$11.16
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.71
|
| Rate for Payer: Priority Health Medicare |
$20.40
|
| Rate for Payer: Priority Health Narrow Network |
$33.32
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.30
|
| Rate for Payer: UHC Medicare Advantage |
$21.01
|
| Rate for Payer: VA VA |
$20.40
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$280.46 |
| Max. Negotiated Rate |
$400.66 |
| Rate for Payer: Aetna Commercial |
$360.59
|
| Rate for Payer: ASR ASR |
$388.64
|
| Rate for Payer: BCBS Trust/PPO |
$310.63
|
| Rate for Payer: BCN Commercial |
$310.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$400.66
|
| Rate for Payer: Healthscope Whirlpool |
$388.64
|
| Rate for Payer: Mclaren Commercial |
$360.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.58
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.26 |
| Max. Negotiated Rate |
$400.66 |
| Rate for Payer: Aetna Commercial |
$360.59
|
| Rate for Payer: ASR ASR |
$388.64
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS Trust/PPO |
$310.63
|
| Rate for Payer: BCN Commercial |
$310.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$400.66
|
| Rate for Payer: Healthscope Whirlpool |
$388.64
|
| Rate for Payer: Mclaren Commercial |
$360.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.60
|
| Rate for Payer: Priority Health Narrow Network |
$284.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.58
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$351.57
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$378.91
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$302.86
|
| Rate for Payer: BCN Commercial |
$302.86
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$367.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Healthscope Whirlpool |
$378.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$351.57
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.47
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$277.35
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.75
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$273.44 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$351.57
|
| Rate for Payer: ASR ASR |
$378.91
|
| Rate for Payer: BCBS Trust/PPO |
$302.86
|
| Rate for Payer: BCN Commercial |
$302.86
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$367.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Healthscope Whirlpool |
$378.91
|
| Rate for Payer: Mclaren Commercial |
$351.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.75
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| 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 |
$59.17
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| 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 |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.51
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$43.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: ASR ASR |
$59.17
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: ASR ASR |
$59.17
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| 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 |
$59.17
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| 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 |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.51
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$43.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: ASR ASR |
$55.29
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Healthscope Commercial |
$57.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.29
|
| Rate for Payer: Mclaren Commercial |
$51.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.16
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: ASR ASR |
$55.29
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$57.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.25
|
| Rate for Payer: Mclaren Commercial |
$51.30
|
| Rate for Payer: Mclaren Medicaid |
$6.70
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$7.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.48
|
| Rate for Payer: PHP Medicaid |
$6.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.87
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health Narrow Network |
$40.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.16
|
| Rate for Payer: UHC Medicare Advantage |
$12.62
|
| Rate for Payer: VA VA |
$12.25
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,996.08 |
| Max. Negotiated Rate |
$36,554.11 |
| Rate for Payer: Aetna Commercial |
$22,032.00
|
| Rate for Payer: Aetna Medicare |
$29,243.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,554.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,554.11
|
| Rate for Payer: ASR ASR |
$23,745.60
|
| Rate for Payer: BCBS Complete |
$16,797.35
|
| Rate for Payer: BCBS MAPPO |
$29,243.29
|
| Rate for Payer: BCBS Trust/PPO |
$18,979.34
|
| Rate for Payer: BCN Commercial |
$18,979.34
|
| Rate for Payer: BCN Medicare Advantage |
$29,243.29
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$23,011.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,243.29
|
| Rate for Payer: Healthscope Commercial |
$24,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$23,745.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,243.29
|
| Rate for Payer: Mclaren Commercial |
$22,032.00
|
| Rate for Payer: Mclaren Medicaid |
$15,996.08
|
| Rate for Payer: Mclaren Medicare |
$29,243.29
|
| Rate for Payer: Meridian Medicaid |
$16,797.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,705.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,629.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Medicare |
$27,781.13
|
| Rate for Payer: PACE SWMI |
$29,243.29
|
| Rate for Payer: PHP Commercial |
$32,167.62
|
| Rate for Payer: PHP Medicaid |
$15,996.08
|
| Rate for Payer: PHP Medicare Advantage |
$29,243.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,996.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,276.80
|
| Rate for Payer: Priority Health Medicare |
$29,243.29
|
| Rate for Payer: Priority Health Narrow Network |
$17,380.80
|
| Rate for Payer: Railroad Medicare Medicare |
$29,243.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,542.40
|
| Rate for Payer: UHC Medicare Advantage |
$30,120.59
|
| Rate for Payer: VA VA |
$29,243.29
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
IP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,136.00 |
| Max. Negotiated Rate |
$24,480.00 |
| Rate for Payer: Aetna Commercial |
$22,032.00
|
| Rate for Payer: ASR ASR |
$23,745.60
|
| Rate for Payer: BCBS Trust/PPO |
$18,979.34
|
| Rate for Payer: BCN Commercial |
$18,979.34
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$23,011.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Healthscope Commercial |
$24,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$23,745.60
|
| Rate for Payer: Mclaren Commercial |
$22,032.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,542.40
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
IP
|
$11,220.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,854.00 |
| Max. Negotiated Rate |
$11,220.00 |
| Rate for Payer: Aetna Commercial |
$10,098.00
|
| Rate for Payer: ASR ASR |
$10,883.40
|
| Rate for Payer: BCBS Trust/PPO |
$8,698.87
|
| Rate for Payer: BCN Commercial |
$8,698.87
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cofinity Commercial |
$10,546.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,976.00
|
| Rate for Payer: Healthscope Commercial |
$11,220.00
|
| Rate for Payer: Healthscope Whirlpool |
$10,883.40
|
| Rate for Payer: Mclaren Commercial |
$10,098.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,537.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,854.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,873.60
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
OP
|
$11,220.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,854.00 |
| Max. Negotiated Rate |
$26,190.15 |
| Rate for Payer: Aetna Commercial |
$10,098.00
|
| Rate for Payer: Aetna Medicare |
$20,952.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,190.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,190.15
|
| Rate for Payer: ASR ASR |
$10,883.40
|
| Rate for Payer: BCBS Complete |
$12,034.90
|
| Rate for Payer: BCBS MAPPO |
$20,952.12
|
| Rate for Payer: BCBS Trust/PPO |
$8,698.87
|
| Rate for Payer: BCN Commercial |
$8,698.87
|
| Rate for Payer: BCN Medicare Advantage |
$20,952.12
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cofinity Commercial |
$10,546.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,976.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,952.12
|
| Rate for Payer: Healthscope Commercial |
$11,220.00
|
| Rate for Payer: Healthscope Whirlpool |
$10,883.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,952.12
|
| Rate for Payer: Mclaren Commercial |
$10,098.00
|
| Rate for Payer: Mclaren Medicaid |
$11,460.81
|
| Rate for Payer: Mclaren Medicare |
$20,952.12
|
| Rate for Payer: Meridian Medicaid |
$12,034.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,999.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,094.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,537.00
|
| Rate for Payer: PACE Medicare |
$19,904.51
|
| Rate for Payer: PACE SWMI |
$20,952.12
|
| Rate for Payer: PHP Commercial |
$23,047.33
|
| Rate for Payer: PHP Medicaid |
$11,460.81
|
| Rate for Payer: PHP Medicare Advantage |
$20,952.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,460.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,854.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,210.20
|
| Rate for Payer: Priority Health Medicare |
$20,952.12
|
| Rate for Payer: Priority Health Narrow Network |
$7,966.20
|
| Rate for Payer: Railroad Medicare Medicare |
$20,952.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,873.60
|
| Rate for Payer: UHC Medicare Advantage |
$21,580.68
|
| Rate for Payer: VA VA |
$20,952.12
|
|
