|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$1,048.31 |
| Rate for Payer: Aetna Commercial |
$943.48
|
| Rate for Payer: ASR ASR |
$1,016.86
|
| Rate for Payer: BCBS Trust/PPO |
$812.75
|
| Rate for Payer: BCN Commercial |
$812.75
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$985.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Healthscope Commercial |
$1,048.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.86
|
| Rate for Payer: Mclaren Commercial |
$943.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.51
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,048.31 |
| Rate for Payer: Aetna Commercial |
$943.48
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,016.86
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$812.75
|
| Rate for Payer: BCN Commercial |
$812.75
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$985.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,048.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$943.48
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$953.96
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$744.30
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.51
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.28 |
| Max. Negotiated Rate |
$1,901.83 |
| Rate for Payer: Aetna Commercial |
$1,711.65
|
| Rate for Payer: ASR ASR |
$1,844.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.49
|
| Rate for Payer: BCN Commercial |
$1,474.49
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Healthscope Commercial |
$1,901.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,844.78
|
| Rate for Payer: Mclaren Commercial |
$1,711.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,673.61
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$1,901.83 |
| Rate for Payer: Aetna Commercial |
$1,711.65
|
| Rate for Payer: Aetna Medicare |
$221.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.42
|
| Rate for Payer: ASR ASR |
$1,844.78
|
| Rate for Payer: BCBS Complete |
$127.02
|
| Rate for Payer: BCBS MAPPO |
$221.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.49
|
| Rate for Payer: BCN Commercial |
$1,474.49
|
| Rate for Payer: BCN Medicare Advantage |
$221.14
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.14
|
| Rate for Payer: Healthscope Commercial |
$1,901.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,844.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$221.14
|
| Rate for Payer: Mclaren Commercial |
$1,711.65
|
| Rate for Payer: Mclaren Medicaid |
$120.96
|
| Rate for Payer: Mclaren Medicare |
$221.14
|
| Rate for Payer: Meridian Medicaid |
$127.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PACE Medicare |
$210.08
|
| Rate for Payer: PACE SWMI |
$221.14
|
| Rate for Payer: PHP Commercial |
$243.25
|
| Rate for Payer: PHP Medicaid |
$120.96
|
| Rate for Payer: PHP Medicare Advantage |
$221.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,730.67
|
| Rate for Payer: Priority Health Medicare |
$221.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.30
|
| Rate for Payer: Railroad Medicare Medicare |
$221.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,673.61
|
| Rate for Payer: UHC Medicare Advantage |
$227.77
|
| Rate for Payer: VA VA |
$221.14
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: ASR ASR |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$1.00
|
| Rate for Payer: Healthscope Whirlpool |
$0.97
|
| Rate for Payer: Mclaren Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.91
|
| Rate for Payer: Priority Health Narrow Network |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.88
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: ASR ASR |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$1.00
|
| Rate for Payer: Healthscope Whirlpool |
$0.97
|
| Rate for Payer: Mclaren Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.88
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$85.59 |
| Rate for Payer: Aetna Commercial |
$77.03
|
| Rate for Payer: ASR ASR |
$83.02
|
| Rate for Payer: BCBS Trust/PPO |
$66.36
|
| Rate for Payer: BCN Commercial |
$66.36
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$80.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Healthscope Commercial |
$85.59
|
| Rate for Payer: Healthscope Whirlpool |
$83.02
|
| Rate for Payer: Mclaren Commercial |
$77.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.32
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$85.59 |
| Rate for Payer: Aetna Commercial |
$77.03
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$83.02
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$66.36
|
| Rate for Payer: BCN Commercial |
$66.36
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$80.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$85.59
|
| Rate for Payer: Healthscope Whirlpool |
$83.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$77.03
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.89
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$60.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.32
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,694.92 |
| Max. Negotiated Rate |
$2,421.31 |
| Rate for Payer: Aetna Commercial |
$2,179.18
|
| Rate for Payer: ASR ASR |
$2,348.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.24
|
| Rate for Payer: BCN Commercial |
$1,877.24
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,276.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Healthscope Commercial |
$2,421.31
|
| Rate for Payer: Healthscope Whirlpool |
$2,348.67
|
| Rate for Payer: Mclaren Commercial |
$2,179.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,130.75
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$578.66 |
| Max. Negotiated Rate |
$2,421.31 |
| Rate for Payer: Aetna Commercial |
$2,179.18
|
| Rate for Payer: Aetna Medicare |
$1,057.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,322.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,322.35
|
| Rate for Payer: ASR ASR |
$2,348.67
|
| Rate for Payer: BCBS Complete |
$607.65
|
| Rate for Payer: BCBS MAPPO |
$1,057.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.24
|
| Rate for Payer: BCN Commercial |
$1,877.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.88
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,276.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.88
|
| Rate for Payer: Healthscope Commercial |
$2,421.31
|
| Rate for Payer: Healthscope Whirlpool |
$2,348.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,057.88
|
| Rate for Payer: Mclaren Commercial |
$2,179.18
|
| Rate for Payer: Mclaren Medicaid |
$578.66
|
| Rate for Payer: Mclaren Medicare |
$1,057.88
|
| Rate for Payer: Meridian Medicaid |
$607.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,110.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PACE Medicare |
$1,004.99
|
| Rate for Payer: PACE SWMI |
$1,057.88
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: PHP Medicaid |
$578.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,203.39
|
| Rate for Payer: Priority Health Medicare |
$1,057.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,719.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,130.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,089.62
|
| Rate for Payer: VA VA |
$1,057.88
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$777.32 |
| Max. Negotiated Rate |
$1,110.46 |
| Rate for Payer: Aetna Commercial |
$999.41
|
| Rate for Payer: ASR ASR |
$1,077.15
|
| Rate for Payer: BCBS Trust/PPO |
$860.94
|
| Rate for Payer: BCN Commercial |
$860.94
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$1,043.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.37
|
| Rate for Payer: Healthscope Commercial |
$1,110.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,077.15
|
| Rate for Payer: Mclaren Commercial |
$999.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.20
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$444.18 |
| Max. Negotiated Rate |
$1,110.46 |
| Rate for Payer: Aetna Commercial |
$999.41
|
| Rate for Payer: ASR ASR |
$1,077.15
|
| Rate for Payer: BCBS Complete |
$444.18
|
| Rate for Payer: BCBS Trust/PPO |
$860.94
|
| Rate for Payer: BCN Commercial |
$860.94
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$1,043.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.37
|
| Rate for Payer: Healthscope Commercial |
$1,110.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,077.15
|
| Rate for Payer: Mclaren Commercial |
$999.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,010.52
|
| Rate for Payer: Priority Health Narrow Network |
$788.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.20
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.48 |
| Max. Negotiated Rate |
$906.19 |
| Rate for Payer: Aetna Commercial |
$815.57
|
| Rate for Payer: ASR ASR |
$879.00
|
| Rate for Payer: BCBS Complete |
$362.48
|
| Rate for Payer: BCBS Trust/PPO |
$702.57
|
| Rate for Payer: BCN Commercial |
$702.57
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$851.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.95
|
| Rate for Payer: Healthscope Commercial |
$906.19
|
| Rate for Payer: Healthscope Whirlpool |
$879.00
|
| Rate for Payer: Mclaren Commercial |
$815.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.63
|
| Rate for Payer: Priority Health Narrow Network |
$643.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.45
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$634.33 |
| Max. Negotiated Rate |
$906.19 |
| Rate for Payer: Aetna Commercial |
$815.57
|
| Rate for Payer: ASR ASR |
$879.00
|
| Rate for Payer: BCBS Trust/PPO |
$702.57
|
| Rate for Payer: BCN Commercial |
$702.57
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$851.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.95
|
| Rate for Payer: Healthscope Commercial |
$906.19
|
| Rate for Payer: Healthscope Whirlpool |
$879.00
|
| Rate for Payer: Mclaren Commercial |
$815.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.45
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Aetna Commercial |
$316.71
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$341.34
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$272.83
|
| Rate for Payer: BCN Commercial |
$272.83
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$330.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$351.90
|
| Rate for Payer: Healthscope Whirlpool |
$341.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$316.71
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.67
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.33 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Aetna Commercial |
$316.71
|
| Rate for Payer: ASR ASR |
$341.34
|
| Rate for Payer: BCBS Trust/PPO |
$272.83
|
| Rate for Payer: BCN Commercial |
$272.83
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$330.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Healthscope Commercial |
$351.90
|
| Rate for Payer: Healthscope Whirlpool |
$341.34
|
| Rate for Payer: Mclaren Commercial |
$316.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.67
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,877.64 |
| Rate for Payer: Aetna Commercial |
$3,489.88
|
| 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 |
$3,761.31
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,006.33
|
| Rate for Payer: BCN Commercial |
$3,006.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$3,644.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,877.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,761.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,489.88
|
| 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 |
$3,295.99
|
| 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 |
$2,714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,375.21
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,900.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,412.32
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,714.35 |
| Max. Negotiated Rate |
$3,877.64 |
| Rate for Payer: Aetna Commercial |
$3,489.88
|
| Rate for Payer: ASR ASR |
$3,761.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,006.33
|
| Rate for Payer: BCN Commercial |
$3,006.33
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$3,644.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.11
|
| Rate for Payer: Healthscope Commercial |
$3,877.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,761.31
|
| Rate for Payer: Mclaren Commercial |
$3,489.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,295.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,714.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,412.32
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,551.92 |
| Max. Negotiated Rate |
$9,359.88 |
| Rate for Payer: Aetna Commercial |
$8,423.89
|
| Rate for Payer: ASR ASR |
$9,079.08
|
| Rate for Payer: BCBS Trust/PPO |
$7,256.71
|
| Rate for Payer: BCN Commercial |
$7,256.71
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,798.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Healthscope Commercial |
$9,359.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,079.08
|
| Rate for Payer: Mclaren Commercial |
$8,423.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,236.69
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$9,359.88 |
| Rate for Payer: Aetna Commercial |
$8,423.89
|
| 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 |
$9,079.08
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,256.71
|
| Rate for Payer: BCN Commercial |
$7,256.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,798.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$9,359.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,079.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$8,423.89
|
| 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 |
$7,955.90
|
| 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 |
$6,551.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,375.21
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,900.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,236.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$320.40 |
| Rate for Payer: Aetna Commercial |
$288.36
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$310.79
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$248.41
|
| Rate for Payer: BCN Commercial |
$248.41
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$301.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$320.40
|
| Rate for Payer: Healthscope Whirlpool |
$310.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$288.36
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.78
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$212.62
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.95
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.28 |
| Max. Negotiated Rate |
$320.40 |
| Rate for Payer: Aetna Commercial |
$288.36
|
| Rate for Payer: ASR ASR |
$310.79
|
| Rate for Payer: BCBS Trust/PPO |
$248.41
|
| Rate for Payer: BCN Commercial |
$248.41
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$301.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.32
|
| Rate for Payer: Healthscope Commercial |
$320.40
|
| Rate for Payer: Healthscope Whirlpool |
$310.79
|
| Rate for Payer: Mclaren Commercial |
$288.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.95
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,298.86 |
| Max. Negotiated Rate |
$3,247.14 |
| Rate for Payer: Aetna Commercial |
$2,922.43
|
| Rate for Payer: ASR ASR |
$3,149.73
|
| Rate for Payer: BCBS Complete |
$1,298.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.51
|
| Rate for Payer: BCN Commercial |
$2,517.51
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$3,052.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,597.71
|
| Rate for Payer: Healthscope Commercial |
$3,247.14
|
| Rate for Payer: Healthscope Whirlpool |
$3,149.73
|
| Rate for Payer: Mclaren Commercial |
$2,922.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,954.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,305.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,857.48
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,273.00 |
| Max. Negotiated Rate |
$3,247.14 |
| Rate for Payer: Aetna Commercial |
$2,922.43
|
| Rate for Payer: ASR ASR |
$3,149.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.51
|
| Rate for Payer: BCN Commercial |
$2,517.51
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$3,052.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,597.71
|
| Rate for Payer: Healthscope Commercial |
$3,247.14
|
| Rate for Payer: Healthscope Whirlpool |
$3,149.73
|
| Rate for Payer: Mclaren Commercial |
$2,922.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,857.48
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,427.92
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,099.54 |
| Max. Negotiated Rate |
$4,427.92 |
| Rate for Payer: Aetna Commercial |
$3,985.13
|
| Rate for Payer: ASR ASR |
$4,295.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,432.97
|
| Rate for Payer: BCN Commercial |
$3,432.97
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$4,162.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.34
|
| Rate for Payer: Healthscope Commercial |
$4,427.92
|
| Rate for Payer: Healthscope Whirlpool |
$4,295.08
|
| Rate for Payer: Mclaren Commercial |
$3,985.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,763.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,099.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,896.57
|
|
