|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$380.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: ASR ASR |
$921.50
|
| Rate for Payer: BCBS Complete |
$380.00
|
| Rate for Payer: BCBS Trust/PPO |
$736.54
|
| Rate for Payer: BCN Commercial |
$736.54
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$893.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$950.00
|
| Rate for Payer: Healthscope Whirlpool |
$921.50
|
| Rate for Payer: Mclaren Commercial |
$855.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$864.50
|
| Rate for Payer: Priority Health Narrow Network |
$674.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.00
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: ASR ASR |
$921.50
|
| Rate for Payer: BCBS Trust/PPO |
$736.54
|
| Rate for Payer: BCN Commercial |
$736.54
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$893.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$950.00
|
| Rate for Payer: Healthscope Whirlpool |
$921.50
|
| Rate for Payer: Mclaren Commercial |
$855.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.00
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$678.30 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$751.27
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$339.77 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$621.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$776.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$776.44
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: BCBS Complete |
$356.79
|
| Rate for Payer: BCBS MAPPO |
$621.15
|
| Rate for Payer: BCBS Trust/PPO |
$751.27
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$621.15
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.15
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$621.15
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$339.77
|
| Rate for Payer: Mclaren Medicare |
$621.15
|
| Rate for Payer: Meridian Medicaid |
$356.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Medicare |
$590.09
|
| Rate for Payer: PACE SWMI |
$621.15
|
| Rate for Payer: PHP Commercial |
$683.26
|
| Rate for Payer: PHP Medicaid |
$339.77
|
| Rate for Payer: PHP Medicare Advantage |
$621.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.79
|
| Rate for Payer: Priority Health Medicare |
$621.15
|
| Rate for Payer: Priority Health Narrow Network |
$687.99
|
| Rate for Payer: Railroad Medicare Medicare |
$621.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Medicare Advantage |
$639.78
|
| Rate for Payer: VA VA |
$621.15
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
OP
|
$135.92
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Aetna Commercial |
$122.33
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: ASR ASR |
$131.84
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$105.38
|
| Rate for Payer: BCN Commercial |
$105.38
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cofinity Commercial |
$127.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$135.92
|
| Rate for Payer: Healthscope Whirlpool |
$131.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.59
|
| Rate for Payer: Mclaren Commercial |
$122.33
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.53
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicaid |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.75
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$86.20
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.61
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: VA VA |
$189.59
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
IP
|
$135.92
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.14 |
| Max. Negotiated Rate |
$135.92 |
| Rate for Payer: Aetna Commercial |
$122.33
|
| Rate for Payer: ASR ASR |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$105.38
|
| Rate for Payer: BCN Commercial |
$105.38
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cofinity Commercial |
$127.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.74
|
| Rate for Payer: Healthscope Commercial |
$135.92
|
| Rate for Payer: Healthscope Whirlpool |
$131.84
|
| Rate for Payer: Mclaren Commercial |
$122.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.61
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
IP
|
$860.90
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$602.63 |
| Max. Negotiated Rate |
$860.90 |
| Rate for Payer: Aetna Commercial |
$774.81
|
| Rate for Payer: ASR ASR |
$835.07
|
| Rate for Payer: BCBS Trust/PPO |
$667.46
|
| Rate for Payer: BCN Commercial |
$667.46
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cofinity Commercial |
$809.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.72
|
| Rate for Payer: Healthscope Commercial |
$860.90
|
| Rate for Payer: Healthscope Whirlpool |
$835.07
|
| Rate for Payer: Mclaren Commercial |
$774.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.59
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
OP
|
$860.90
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$233.56 |
| Max. Negotiated Rate |
$860.90 |
| Rate for Payer: Aetna Commercial |
$774.81
|
| Rate for Payer: ASR ASR |
$835.07
|
| Rate for Payer: BCBS Complete |
$344.36
|
| Rate for Payer: BCBS Trust/PPO |
$667.46
|
| Rate for Payer: BCN Commercial |
$667.46
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cofinity Commercial |
$809.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.72
|
| Rate for Payer: Healthscope Commercial |
$860.90
|
| Rate for Payer: Healthscope Whirlpool |
$835.07
|
| Rate for Payer: Mclaren Commercial |
$774.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.95
|
| Rate for Payer: Priority Health Narrow Network |
$233.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.59
|
|
|
HC IR ABSCESS DRAIN TUBE CHECK
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC IR ABSCESS DRAIN TUBE CHECK
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$612.96 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: Aetna Medicare |
$490.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$490.37
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$539.41
|
| Rate for Payer: PHP Medicaid |
$268.23
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.04
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$377.63
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: VA VA |
$490.37
|
|
|
HC IR ANGIO FU EMBO THROMBOLYSIS
|
Facility
|
OP
|
$1,683.20
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
32000212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,178.24 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$1,514.88
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$1,632.70
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.98
|
| Rate for Payer: BCN Commercial |
$1,304.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$1,346.56
|
| Rate for Payer: Cash Price |
$1,346.56
|
| Rate for Payer: Cofinity Commercial |
$1,582.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,346.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$1,683.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,632.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$1,514.88
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,430.72
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,178.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,531.71
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.07
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,481.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC IR ANGIO FU EMBO THROMBOLYSIS
|
Facility
|
IP
|
$1,683.20
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
32000212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,178.24 |
| Max. Negotiated Rate |
$1,683.20 |
| Rate for Payer: Aetna Commercial |
$1,514.88
|
| Rate for Payer: ASR ASR |
$1,632.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.98
|
| Rate for Payer: BCN Commercial |
$1,304.98
|
| Rate for Payer: Cash Price |
$1,346.56
|
| Rate for Payer: Cofinity Commercial |
$1,582.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,346.56
|
| Rate for Payer: Healthscope Commercial |
$1,683.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,632.70
|
| Rate for Payer: Mclaren Commercial |
$1,514.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,430.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,178.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,481.22
|
|
|
HC IR ANGIOGRAM PELVIC
|
Facility
|
IP
|
$3,202.09
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
32000194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,241.46 |
| Max. Negotiated Rate |
$3,202.09 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
|
|
HC IR ANGIOGRAM PELVIC
|
Facility
|
OP
|
$3,202.09
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
32000194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,241.46 |
| Max. Negotiated Rate |
$6,105.86 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,913.90
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,273.48
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC IR ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$3,389.80
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
36100273
|
|
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 IR ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$3,389.80
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
36100273
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,355.92 |
| 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 Complete |
$1,355.92
|
| 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: Priority Health HMO/PPO/Tiered Network |
$3,084.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,406.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,983.02
|
|
|
HC IR ANGIOPLASTY INTRACRANIAL VASOSPASM INIT
|
Facility
|
OP
|
$9,660.92
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
36100275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,864.37 |
| Max. Negotiated Rate |
$9,660.92 |
| Rate for Payer: Aetna Commercial |
$8,694.83
|
| Rate for Payer: ASR ASR |
$9,371.09
|
| Rate for Payer: BCBS Complete |
$3,864.37
|
| Rate for Payer: BCBS Trust/PPO |
$7,490.11
|
| Rate for Payer: BCN Commercial |
$7,490.11
|
| Rate for Payer: Cash Price |
$7,728.74
|
| Rate for Payer: Cofinity Commercial |
$9,081.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,728.74
|
| Rate for Payer: Healthscope Commercial |
$9,660.92
|
| Rate for Payer: Healthscope Whirlpool |
$9,371.09
|
| Rate for Payer: Mclaren Commercial |
$8,694.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,211.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,762.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,791.44
|
| Rate for Payer: Priority Health Narrow Network |
$6,859.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,501.61
|
|
|
HC IR ANGIOPLASTY INTRACRANIAL VASOSPASM INIT
|
Facility
|
IP
|
$9,660.92
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
36100275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,762.64 |
| Max. Negotiated Rate |
$9,660.92 |
| Rate for Payer: Aetna Commercial |
$8,694.83
|
| Rate for Payer: ASR ASR |
$9,371.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,490.11
|
| Rate for Payer: BCN Commercial |
$7,490.11
|
| Rate for Payer: Cash Price |
$7,728.74
|
| Rate for Payer: Cofinity Commercial |
$9,081.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,728.74
|
| Rate for Payer: Healthscope Commercial |
$9,660.92
|
| Rate for Payer: Healthscope Whirlpool |
$9,371.09
|
| Rate for Payer: Mclaren Commercial |
$8,694.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,211.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,762.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,501.61
|
|
|
HC IR AORTAGRAM ABDOMEN
|
Facility
|
OP
|
$3,402.31
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$3,062.08
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$3,300.24
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,637.81
|
| Rate for Payer: BCN Commercial |
$2,637.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cofinity Commercial |
$3,198.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,721.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,402.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,300.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,062.08
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,891.96
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,096.10
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,415.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,994.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC IR AORTAGRAM ABDOMEN
|
Facility
|
IP
|
$3,402.31
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,381.62 |
| Max. Negotiated Rate |
$3,402.31 |
| Rate for Payer: Aetna Commercial |
$3,062.08
|
| Rate for Payer: ASR ASR |
$3,300.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,637.81
|
| Rate for Payer: BCN Commercial |
$2,637.81
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cofinity Commercial |
$3,198.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,721.85
|
| Rate for Payer: Healthscope Commercial |
$3,402.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,300.24
|
| Rate for Payer: Mclaren Commercial |
$3,062.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,891.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,994.03
|
|
|
HC IR AORTAGRAM THORACIC
|
Facility
|
OP
|
$4,035.36
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
32000175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,671.93 |
| Max. Negotiated Rate |
$6,105.86 |
| Rate for Payer: Aetna Commercial |
$3,631.82
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$3,914.30
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,128.61
|
| Rate for Payer: BCN Commercial |
$3,128.61
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$3,228.29
|
| Rate for Payer: Cash Price |
$3,228.29
|
| Rate for Payer: Cofinity Commercial |
$3,793.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,228.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$4,035.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,914.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$3,631.82
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,430.06
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,824.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,672.18
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,865.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,551.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC IR AORTAGRAM THORACIC
|
Facility
|
IP
|
$4,035.36
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
32000175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,824.75 |
| Max. Negotiated Rate |
$4,035.36 |
| Rate for Payer: Aetna Commercial |
$3,631.82
|
| Rate for Payer: ASR ASR |
$3,914.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,128.61
|
| Rate for Payer: BCN Commercial |
$3,128.61
|
| Rate for Payer: Cash Price |
$3,228.29
|
| Rate for Payer: Cofinity Commercial |
$3,793.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,228.29
|
| Rate for Payer: Healthscope Commercial |
$4,035.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,914.30
|
| Rate for Payer: Mclaren Commercial |
$3,631.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,430.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,824.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,551.12
|
|
|
HC IR ARTERIOGRAM
|
Facility
|
OP
|
$3,712.59
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
32000189
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,712.59 |
| Rate for Payer: Aetna Commercial |
$3,341.33
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$3,601.21
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,878.37
|
| Rate for Payer: BCN Commercial |
$2,878.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,970.07
|
| Rate for Payer: Cash Price |
$2,970.07
|
| Rate for Payer: Cofinity Commercial |
$3,489.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,970.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,712.59
|
| Rate for Payer: Healthscope Whirlpool |
$3,601.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,341.33
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,155.70
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,598.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,378.46
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,635.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,267.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
