|
HC INTRACAV APPL - S
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$654.06 |
| Rate for Payer: Aetna Commercial |
$544.50
|
| Rate for Payer: Aetna Commercial |
$385.56
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: ASR ASR |
$586.85
|
| Rate for Payer: ASR ASR |
$415.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS Trust/PPO |
$469.06
|
| Rate for Payer: BCBS Trust/PPO |
$332.14
|
| Rate for Payer: BCN Commercial |
$332.14
|
| Rate for Payer: BCN Commercial |
$469.06
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$568.70
|
| Rate for Payer: Cofinity Commercial |
$402.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Healthscope Commercial |
$605.00
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Healthscope Whirlpool |
$586.85
|
| Rate for Payer: Healthscope Whirlpool |
$415.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Mclaren Commercial |
$385.56
|
| Rate for Payer: Mclaren Commercial |
$544.50
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.55
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Narrow Network |
$304.16
|
| Rate for Payer: Priority Health Narrow Network |
$429.55
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$532.40
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: VA VA |
$523.25
|
| Rate for Payer: VA VA |
$523.25
|
|
|
HC INTRACAV APPL - S
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$423.50 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna Commercial |
$544.50
|
| Rate for Payer: Aetna Commercial |
$385.56
|
| Rate for Payer: ASR ASR |
$415.55
|
| Rate for Payer: ASR ASR |
$586.85
|
| Rate for Payer: BCBS Trust/PPO |
$469.06
|
| Rate for Payer: BCBS Trust/PPO |
$332.14
|
| Rate for Payer: BCN Commercial |
$469.06
|
| Rate for Payer: BCN Commercial |
$332.14
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$568.70
|
| Rate for Payer: Cofinity Commercial |
$402.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.00
|
| Rate for Payer: Healthscope Commercial |
$605.00
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Healthscope Whirlpool |
$415.55
|
| Rate for Payer: Healthscope Whirlpool |
$586.85
|
| Rate for Payer: Mclaren Commercial |
$544.50
|
| Rate for Payer: Mclaren Commercial |
$385.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$532.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.99
|
|
|
HC INTRAOCULAR LENS
|
Facility
|
IP
|
$648.37
|
|
| Hospital Charge Code |
27600003
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$453.86 |
| Max. Negotiated Rate |
$648.37 |
| Rate for Payer: Aetna Commercial |
$583.53
|
| Rate for Payer: ASR ASR |
$628.92
|
| Rate for Payer: BCBS Trust/PPO |
$502.68
|
| Rate for Payer: BCN Commercial |
$502.68
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cofinity Commercial |
$609.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.70
|
| Rate for Payer: Healthscope Commercial |
$648.37
|
| Rate for Payer: Healthscope Whirlpool |
$628.92
|
| Rate for Payer: Mclaren Commercial |
$583.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$551.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.57
|
|
|
HC INTRAOCULAR LENS
|
Facility
|
OP
|
$648.37
|
|
| Hospital Charge Code |
27600003
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$648.37 |
| Rate for Payer: Aetna Commercial |
$583.53
|
| Rate for Payer: ASR ASR |
$628.92
|
| Rate for Payer: BCBS Complete |
$259.35
|
| Rate for Payer: BCBS Trust/PPO |
$502.68
|
| Rate for Payer: BCN Commercial |
$502.68
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cofinity Commercial |
$609.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.70
|
| Rate for Payer: Healthscope Commercial |
$648.37
|
| Rate for Payer: Healthscope Whirlpool |
$628.92
|
| Rate for Payer: Mclaren Commercial |
$583.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$551.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.02
|
| Rate for Payer: Priority Health Narrow Network |
$460.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.57
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
IP
|
$475.38
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.77 |
| Max. Negotiated Rate |
$475.38 |
| Rate for Payer: Aetna Commercial |
$427.84
|
| Rate for Payer: ASR ASR |
$461.12
|
| Rate for Payer: BCBS Trust/PPO |
$368.56
|
| Rate for Payer: BCN Commercial |
$368.56
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cofinity Commercial |
$446.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.30
|
| Rate for Payer: Healthscope Commercial |
$475.38
|
| Rate for Payer: Healthscope Whirlpool |
$461.12
|
| Rate for Payer: Mclaren Commercial |
$427.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.33
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
OP
|
$475.38
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.73 |
| Max. Negotiated Rate |
$475.38 |
| Rate for Payer: Aetna Commercial |
$427.84
|
| Rate for Payer: Aetna Medicare |
$354.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: ASR ASR |
$461.12
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$368.56
|
| Rate for Payer: BCN Commercial |
$368.56
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cofinity Commercial |
$446.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$475.38
|
| Rate for Payer: Healthscope Whirlpool |
$461.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.16
|
| Rate for Payer: Mclaren Commercial |
$427.84
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.07
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Commercial |
$389.58
|
| Rate for Payer: PHP Medicaid |
$193.73
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.60
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$337.52
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.33
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: ASR ASR |
$278.39
|
| Rate for Payer: BCBS Trust/PPO |
$222.51
|
| Rate for Payer: BCN Commercial |
$222.51
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.60
|
| Rate for Payer: Healthscope Commercial |
$287.00
|
| Rate for Payer: Healthscope Whirlpool |
$278.39
|
| Rate for Payer: Mclaren Commercial |
$258.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.56
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: ASR ASR |
$278.39
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Trust/PPO |
$222.51
|
| Rate for Payer: BCN Commercial |
$222.51
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.60
|
| Rate for Payer: Healthscope Commercial |
$287.00
|
| Rate for Payer: Healthscope Whirlpool |
$278.39
|
| Rate for Payer: Mclaren Commercial |
$258.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.17
|
| Rate for Payer: Priority Health Narrow Network |
$203.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.56
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
OP
|
$1,730.82
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$692.33 |
| Max. Negotiated Rate |
$1,730.82 |
| Rate for Payer: Aetna Commercial |
$1,557.74
|
| Rate for Payer: ASR ASR |
$1,678.90
|
| Rate for Payer: BCBS Complete |
$692.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.90
|
| Rate for Payer: BCN Commercial |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,384.66
|
| Rate for Payer: Cofinity Commercial |
$1,626.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,384.66
|
| Rate for Payer: Healthscope Commercial |
$1,730.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,678.90
|
| Rate for Payer: Mclaren Commercial |
$1,557.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,575.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,523.12
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
IP
|
$1,730.82
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,211.57 |
| Max. Negotiated Rate |
$1,730.82 |
| Rate for Payer: Aetna Commercial |
$1,557.74
|
| Rate for Payer: ASR ASR |
$1,678.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.90
|
| Rate for Payer: BCN Commercial |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,384.66
|
| Rate for Payer: Cofinity Commercial |
$1,626.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,384.66
|
| Rate for Payer: Healthscope Commercial |
$1,730.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,678.90
|
| Rate for Payer: Mclaren Commercial |
$1,557.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,523.12
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
IP
|
$3,693.37
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,585.36 |
| Max. Negotiated Rate |
$3,693.37 |
| Rate for Payer: Aetna Commercial |
$3,324.03
|
| Rate for Payer: ASR ASR |
$3,582.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.47
|
| Rate for Payer: BCN Commercial |
$2,863.47
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,471.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.70
|
| Rate for Payer: Healthscope Commercial |
$3,693.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.57
|
| Rate for Payer: Mclaren Commercial |
$3,324.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.17
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
OP
|
$3,693.37
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,585.36 |
| Max. Negotiated Rate |
$8,297.88 |
| Rate for Payer: Aetna Commercial |
$3,324.03
|
| Rate for Payer: Aetna Medicare |
$6,638.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,297.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,297.88
|
| Rate for Payer: ASR ASR |
$3,582.57
|
| Rate for Payer: BCBS Complete |
$3,813.04
|
| Rate for Payer: BCBS MAPPO |
$6,638.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.47
|
| Rate for Payer: BCN Commercial |
$2,863.47
|
| Rate for Payer: BCN Medicare Advantage |
$6,638.30
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,471.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,638.30
|
| Rate for Payer: Healthscope Commercial |
$3,693.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,638.30
|
| Rate for Payer: Mclaren Commercial |
$3,324.03
|
| Rate for Payer: Mclaren Medicaid |
$3,631.15
|
| Rate for Payer: Mclaren Medicare |
$6,638.30
|
| Rate for Payer: Meridian Medicaid |
$3,813.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,970.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,634.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PACE Medicare |
$6,306.38
|
| Rate for Payer: PACE SWMI |
$6,638.30
|
| Rate for Payer: PHP Commercial |
$7,302.13
|
| Rate for Payer: PHP Medicaid |
$3,631.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,638.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,360.97
|
| Rate for Payer: Priority Health Medicare |
$6,638.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,622.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6,638.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.17
|
| Rate for Payer: UHC Medicare Advantage |
$6,837.45
|
| Rate for Payer: VA VA |
$6,638.30
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Medicaid |
$8.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.25
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.68
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$34.08
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$15.53
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,468.80 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,304.80
|
| Rate for Payer: ASR ASR |
$3,561.84
|
| Rate for Payer: BCBS Complete |
$1,468.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.90
|
| Rate for Payer: BCN Commercial |
$2,846.90
|
| Rate for Payer: Cash Price |
$2,937.60
|
| Rate for Payer: Cofinity Commercial |
$3,451.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,937.60
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,561.84
|
| Rate for Payer: Mclaren Commercial |
$3,304.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,121.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,341.52
|
| Rate for Payer: Priority Health Narrow Network |
$2,607.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,231.36
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,304.80
|
| Rate for Payer: ASR ASR |
$3,561.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.90
|
| Rate for Payer: BCN Commercial |
$2,846.90
|
| Rate for Payer: Cash Price |
$2,937.60
|
| Rate for Payer: Cofinity Commercial |
$3,451.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,937.60
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,561.84
|
| Rate for Payer: Mclaren Commercial |
$3,304.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,121.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,231.36
|
|
|
HC INTRODUCER
|
Facility
|
IP
|
$293.71
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$293.71 |
| Rate for Payer: Aetna Commercial |
$264.34
|
| Rate for Payer: ASR ASR |
$284.90
|
| Rate for Payer: BCBS Trust/PPO |
$227.71
|
| Rate for Payer: BCN Commercial |
$227.71
|
| Rate for Payer: Cash Price |
$234.97
|
| Rate for Payer: Cofinity Commercial |
$276.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.97
|
| Rate for Payer: Healthscope Commercial |
$293.71
|
| Rate for Payer: Healthscope Whirlpool |
$284.90
|
| Rate for Payer: Mclaren Commercial |
$264.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.46
|
|
|
HC INTRODUCER
|
Facility
|
OP
|
$293.71
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.48 |
| Max. Negotiated Rate |
$293.71 |
| Rate for Payer: Aetna Commercial |
$264.34
|
| Rate for Payer: ASR ASR |
$284.90
|
| Rate for Payer: BCBS Complete |
$117.48
|
| Rate for Payer: BCBS Trust/PPO |
$227.71
|
| Rate for Payer: BCN Commercial |
$227.71
|
| Rate for Payer: Cash Price |
$234.97
|
| Rate for Payer: Cofinity Commercial |
$276.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.97
|
| Rate for Payer: Healthscope Commercial |
$293.71
|
| Rate for Payer: Healthscope Whirlpool |
$284.90
|
| Rate for Payer: Mclaren Commercial |
$264.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.28
|
| Rate for Payer: Priority Health Narrow Network |
$208.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.46
|
|
|
HC INTRODUCER LONG
|
Facility
|
IP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.95 |
| Max. Negotiated Rate |
$249.93 |
| Rate for Payer: Aetna Commercial |
$224.94
|
| Rate for Payer: ASR ASR |
$242.43
|
| Rate for Payer: BCBS Trust/PPO |
$193.77
|
| Rate for Payer: BCN Commercial |
$193.77
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Healthscope Commercial |
$249.93
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.94
|
|
|
HC INTRODUCER LONG
|
Facility
|
OP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$249.93 |
| Rate for Payer: Aetna Commercial |
$224.94
|
| Rate for Payer: ASR ASR |
$242.43
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$193.77
|
| Rate for Payer: BCN Commercial |
$193.77
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Healthscope Commercial |
$249.93
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.44
|
| Rate for Payer: Priority Health Narrow Network |
$177.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.94
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
IP
|
$92.82
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Aetna Commercial |
$83.54
|
| Rate for Payer: ASR ASR |
$90.04
|
| Rate for Payer: BCBS Trust/PPO |
$71.96
|
| Rate for Payer: BCN Commercial |
$71.96
|
| Rate for Payer: Cash Price |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$87.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.26
|
| Rate for Payer: Healthscope Commercial |
$92.82
|
| Rate for Payer: Healthscope Whirlpool |
$90.04
|
| Rate for Payer: Mclaren Commercial |
$83.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.68
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
OP
|
$92.82
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Aetna Commercial |
$83.54
|
| Rate for Payer: ASR ASR |
$90.04
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$71.96
|
| Rate for Payer: BCN Commercial |
$71.96
|
| Rate for Payer: Cash Price |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$87.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.26
|
| Rate for Payer: Healthscope Commercial |
$92.82
|
| Rate for Payer: Healthscope Whirlpool |
$90.04
|
| Rate for Payer: Mclaren Commercial |
$83.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.47
|
| Rate for Payer: Priority Health Narrow Network |
$65.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.68
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
IP
|
$3,389.80
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,372.86 |
| Max. Negotiated Rate |
$3,389.80 |
| Rate for Payer: Aetna Commercial |
$3,050.82
|
| Rate for Payer: ASR ASR |
$3,288.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,628.11
|
| Rate for Payer: BCN Commercial |
$2,628.11
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cofinity Commercial |
$3,186.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,711.84
|
| Rate for Payer: Healthscope Commercial |
$3,389.80
|
| Rate for Payer: Healthscope Whirlpool |
$3,288.11
|
| Rate for Payer: Mclaren Commercial |
$3,050.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,881.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,983.02
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
OP
|
$3,389.80
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,372.86 |
| Max. Negotiated Rate |
$5,749.21 |
| Rate for Payer: Aetna Commercial |
$3,050.82
|
| Rate for Payer: Aetna Medicare |
$4,599.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: ASR ASR |
$3,288.11
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,628.11
|
| Rate for Payer: BCN Commercial |
$2,628.11
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cofinity Commercial |
$3,186.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,711.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Healthscope Commercial |
$3,389.80
|
| Rate for Payer: Healthscope Whirlpool |
$3,288.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,599.37
|
| Rate for Payer: Mclaren Commercial |
$3,050.82
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,881.33
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Commercial |
$5,059.31
|
| Rate for Payer: PHP Medicaid |
$2,515.86
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,084.72
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,406.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,983.02
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
IP
|
$40.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna Commercial |
$36.86
|
| Rate for Payer: ASR ASR |
$39.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.75
|
| Rate for Payer: BCN Commercial |
$31.75
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Commercial |
$38.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$40.95
|
| Rate for Payer: Healthscope Whirlpool |
$39.72
|
| Rate for Payer: Mclaren Commercial |
$36.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.04
|
|
