|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.17 |
| Max. Negotiated Rate |
$258.81 |
| Rate for Payer: Aetna Commercial |
$232.93
|
| Rate for Payer: ASR ASR |
$251.05
|
| Rate for Payer: BCBS Trust/PPO |
$200.66
|
| Rate for Payer: BCN Commercial |
$200.66
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$243.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Healthscope Commercial |
$258.81
|
| Rate for Payer: Healthscope Whirlpool |
$251.05
|
| Rate for Payer: Mclaren Commercial |
$232.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.75
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,303.71 |
| Max. Negotiated Rate |
$3,291.02 |
| Rate for Payer: Aetna Commercial |
$2,961.92
|
| Rate for Payer: ASR ASR |
$3,192.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,551.53
|
| Rate for Payer: BCN Commercial |
$2,551.53
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$3,093.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Healthscope Commercial |
$3,291.02
|
| Rate for Payer: Healthscope Whirlpool |
$3,192.29
|
| Rate for Payer: Mclaren Commercial |
$2,961.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,896.10
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
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 MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| 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 |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,563.20 |
| Max. Negotiated Rate |
$29,376.00 |
| Rate for Payer: Aetna Commercial |
$26,438.40
|
| Rate for Payer: ASR ASR |
$28,494.72
|
| Rate for Payer: BCBS Trust/PPO |
$22,775.21
|
| Rate for Payer: BCN Commercial |
$22,775.21
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$27,613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Healthscope Commercial |
$29,376.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,494.72
|
| Rate for Payer: Mclaren Commercial |
$26,438.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,850.88
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,750.40 |
| Max. Negotiated Rate |
$29,376.00 |
| Rate for Payer: Aetna Commercial |
$26,438.40
|
| Rate for Payer: ASR ASR |
$28,494.72
|
| Rate for Payer: BCBS Complete |
$11,750.40
|
| Rate for Payer: BCBS Trust/PPO |
$22,775.21
|
| Rate for Payer: BCN Commercial |
$22,775.21
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$27,613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Healthscope Commercial |
$29,376.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,494.72
|
| Rate for Payer: Mclaren Commercial |
$26,438.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,732.16
|
| Rate for Payer: Priority Health Narrow Network |
$20,856.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,850.88
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,434.33 |
| Max. Negotiated Rate |
$6,085.82 |
| Rate for Payer: Aetna Commercial |
$5,477.24
|
| Rate for Payer: ASR ASR |
$5,903.25
|
| Rate for Payer: BCBS Complete |
$2,434.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,718.34
|
| Rate for Payer: BCN Commercial |
$4,718.34
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$5,720.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Healthscope Commercial |
$6,085.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,903.25
|
| Rate for Payer: Mclaren Commercial |
$5,477.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,538.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,320.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,355.52
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.07 |
| Max. Negotiated Rate |
$6,085.82 |
| Rate for Payer: Aetna Commercial |
$5,477.24
|
| Rate for Payer: ASR ASR |
$5,903.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,718.34
|
| Rate for Payer: BCN Commercial |
$4,718.34
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$5,720.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Healthscope Commercial |
$6,085.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,903.25
|
| Rate for Payer: Mclaren Commercial |
$5,477.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,355.52
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,468.00 |
| Max. Negotiated Rate |
$8,670.00 |
| Rate for Payer: Aetna Commercial |
$7,803.00
|
| Rate for Payer: ASR ASR |
$8,409.90
|
| Rate for Payer: BCBS Complete |
$3,468.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,721.85
|
| Rate for Payer: BCN Commercial |
$6,721.85
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$8,149.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Healthscope Commercial |
$8,670.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,409.90
|
| Rate for Payer: Mclaren Commercial |
$7,803.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,889.70
|
| Rate for Payer: Priority Health Narrow Network |
$6,155.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,629.60
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,069.00 |
| Max. Negotiated Rate |
$8,670.00 |
| Rate for Payer: Aetna Commercial |
$7,803.00
|
| Rate for Payer: ASR ASR |
$8,409.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,721.85
|
| Rate for Payer: BCN Commercial |
$6,721.85
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$8,149.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Healthscope Commercial |
$8,670.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,409.90
|
| Rate for Payer: Mclaren Commercial |
$7,803.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,629.60
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,322.40 |
| Max. Negotiated Rate |
$25,806.00 |
| Rate for Payer: Aetna Commercial |
$23,225.40
|
| Rate for Payer: ASR ASR |
$25,031.82
|
| Rate for Payer: BCBS Complete |
$10,322.40
|
| Rate for Payer: BCBS Trust/PPO |
$20,007.39
|
| Rate for Payer: BCN Commercial |
$20,007.39
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$24,257.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$25,806.00
|
| Rate for Payer: Healthscope Whirlpool |
$25,031.82
|
| Rate for Payer: Mclaren Commercial |
$23,225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,483.46
|
| Rate for Payer: Priority Health Narrow Network |
$18,322.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,709.28
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,064.20 |
| Max. Negotiated Rate |
$25,806.00 |
| Rate for Payer: Aetna Commercial |
$23,225.40
|
| Rate for Payer: ASR ASR |
$25,031.82
|
| Rate for Payer: BCBS Trust/PPO |
$20,007.39
|
| Rate for Payer: BCN Commercial |
$20,007.39
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$24,257.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$25,806.00
|
| Rate for Payer: Healthscope Whirlpool |
$25,031.82
|
| Rate for Payer: Mclaren Commercial |
$23,225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,709.28
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,358.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,350.60 |
| Max. Negotiated Rate |
$23,358.00 |
| Rate for Payer: Aetna Commercial |
$21,022.20
|
| Rate for Payer: ASR ASR |
$22,657.26
|
| Rate for Payer: BCBS Trust/PPO |
$18,109.46
|
| Rate for Payer: BCN Commercial |
$18,109.46
|
| Rate for Payer: Cash Price |
$18,686.40
|
| Rate for Payer: Cofinity Commercial |
$21,956.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
| Rate for Payer: Healthscope Commercial |
$23,358.00
|
| Rate for Payer: Healthscope Whirlpool |
$22,657.26
|
| Rate for Payer: Mclaren Commercial |
$21,022.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20,555.04
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,358.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,343.20 |
| Max. Negotiated Rate |
$23,358.00 |
| Rate for Payer: Aetna Commercial |
$21,022.20
|
| Rate for Payer: ASR ASR |
$22,657.26
|
| Rate for Payer: BCBS Complete |
$9,343.20
|
| Rate for Payer: BCBS Trust/PPO |
$18,109.46
|
| Rate for Payer: BCN Commercial |
$18,109.46
|
| Rate for Payer: Cash Price |
$18,686.40
|
| Rate for Payer: Cofinity Commercial |
$21,956.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
| Rate for Payer: Healthscope Commercial |
$23,358.00
|
| Rate for Payer: Healthscope Whirlpool |
$22,657.26
|
| Rate for Payer: Mclaren Commercial |
$21,022.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,255.78
|
| Rate for Payer: Priority Health Narrow Network |
$16,584.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20,555.04
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$12,956.99
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,069.89 |
| Max. Negotiated Rate |
$12,956.99 |
| Rate for Payer: Aetna Commercial |
$11,661.29
|
| Rate for Payer: ASR ASR |
$12,568.28
|
| Rate for Payer: BCBS Trust/PPO |
$10,045.55
|
| Rate for Payer: BCN Commercial |
$10,045.55
|
| Rate for Payer: Cash Price |
$10,365.59
|
| Rate for Payer: Cofinity Commercial |
$12,179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
| Rate for Payer: Healthscope Commercial |
$12,956.99
|
| Rate for Payer: Healthscope Whirlpool |
$12,568.28
|
| Rate for Payer: Mclaren Commercial |
$11,661.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,402.15
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$12,956.99
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,182.80 |
| Max. Negotiated Rate |
$12,956.99 |
| Rate for Payer: Aetna Commercial |
$11,661.29
|
| Rate for Payer: ASR ASR |
$12,568.28
|
| Rate for Payer: BCBS Complete |
$5,182.80
|
| Rate for Payer: BCBS Trust/PPO |
$10,045.55
|
| Rate for Payer: BCN Commercial |
$10,045.55
|
| Rate for Payer: Cash Price |
$10,365.59
|
| Rate for Payer: Cofinity Commercial |
$12,179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
| Rate for Payer: Healthscope Commercial |
$12,956.99
|
| Rate for Payer: Healthscope Whirlpool |
$12,568.28
|
| Rate for Payer: Mclaren Commercial |
$11,661.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,790.86
|
| Rate for Payer: Priority Health Narrow Network |
$9,199.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,402.15
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,291.65
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,116.66 |
| Max. Negotiated Rate |
$15,291.65 |
| Rate for Payer: Aetna Commercial |
$13,762.48
|
| Rate for Payer: ASR ASR |
$14,832.90
|
| Rate for Payer: BCBS Complete |
$6,116.66
|
| Rate for Payer: BCBS Trust/PPO |
$11,855.62
|
| Rate for Payer: BCN Commercial |
$11,855.62
|
| Rate for Payer: Cash Price |
$12,233.32
|
| Rate for Payer: Cofinity Commercial |
$14,374.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
| Rate for Payer: Healthscope Commercial |
$15,291.65
|
| Rate for Payer: Healthscope Whirlpool |
$14,832.90
|
| Rate for Payer: Mclaren Commercial |
$13,762.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,915.40
|
| Rate for Payer: Priority Health Narrow Network |
$10,857.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,456.65
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,291.65
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,704.16 |
| Max. Negotiated Rate |
$15,291.65 |
| Rate for Payer: Aetna Commercial |
$13,762.48
|
| Rate for Payer: ASR ASR |
$14,832.90
|
| Rate for Payer: BCBS Trust/PPO |
$11,855.62
|
| Rate for Payer: BCN Commercial |
$11,855.62
|
| Rate for Payer: Cash Price |
$12,233.32
|
| Rate for Payer: Cofinity Commercial |
$14,374.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
| Rate for Payer: Healthscope Commercial |
$15,291.65
|
| Rate for Payer: Healthscope Whirlpool |
$14,832.90
|
| Rate for Payer: Mclaren Commercial |
$13,762.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,456.65
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: ASR ASR |
$178.09
|
| Rate for Payer: BCBS Complete |
$73.44
|
| Rate for Payer: BCBS Trust/PPO |
$142.35
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.08
|
| Rate for Payer: Priority Health Narrow Network |
$130.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: ASR ASR |
$178.09
|
| Rate for Payer: BCBS Trust/PPO |
$142.35
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$516.58
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.63 |
| Max. Negotiated Rate |
$516.58 |
| Rate for Payer: Aetna Commercial |
$464.92
|
| Rate for Payer: ASR ASR |
$501.08
|
| Rate for Payer: BCBS Complete |
$206.63
|
| Rate for Payer: BCBS Trust/PPO |
$400.50
|
| Rate for Payer: BCN Commercial |
$400.50
|
| Rate for Payer: Cash Price |
$413.26
|
| Rate for Payer: Cofinity Commercial |
$485.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
| Rate for Payer: Healthscope Commercial |
$516.58
|
| Rate for Payer: Healthscope Whirlpool |
$501.08
|
| Rate for Payer: Mclaren Commercial |
$464.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$470.09
|
| Rate for Payer: Priority Health Narrow Network |
$366.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.59
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$516.58
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$361.61 |
| Max. Negotiated Rate |
$516.58 |
| Rate for Payer: Aetna Commercial |
$464.92
|
| Rate for Payer: ASR ASR |
$501.08
|
| Rate for Payer: BCBS Trust/PPO |
$400.50
|
| Rate for Payer: BCN Commercial |
$400.50
|
| Rate for Payer: Cash Price |
$413.26
|
| Rate for Payer: Cofinity Commercial |
$485.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
| Rate for Payer: Healthscope Commercial |
$516.58
|
| Rate for Payer: Healthscope Whirlpool |
$501.08
|
| Rate for Payer: Mclaren Commercial |
$464.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.59
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$236.64
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.65 |
| Max. Negotiated Rate |
$236.64 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: ASR ASR |
$229.54
|
| Rate for Payer: BCBS Trust/PPO |
$183.47
|
| Rate for Payer: BCN Commercial |
$183.47
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$222.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$236.64
|
| Rate for Payer: Healthscope Whirlpool |
$229.54
|
| Rate for Payer: Mclaren Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.24
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$236.64
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$236.64 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: ASR ASR |
$229.54
|
| Rate for Payer: BCBS Complete |
$94.66
|
| Rate for Payer: BCBS Trust/PPO |
$183.47
|
| Rate for Payer: BCN Commercial |
$183.47
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$222.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$236.64
|
| Rate for Payer: Healthscope Whirlpool |
$229.54
|
| Rate for Payer: Mclaren Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.34
|
| Rate for Payer: Priority Health Narrow Network |
$168.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.24
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$43.10 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: ASR ASR |
$13.45
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$13.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.05
|
| Rate for Payer: Mclaren Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.14
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Medicaid |
$7.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: PHP Medicaid |
$7.14
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.10
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health Narrow Network |
$34.48
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.21
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: VA VA |
$13.05
|
|
