|
HC INTRODUCER
|
Facility
|
IP
|
$305.57
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.18 |
| Max. Negotiated Rate |
$305.57 |
| Rate for Payer: Aetna Commercial |
$275.01
|
| Rate for Payer: ASR ASR |
$296.40
|
| Rate for Payer: BCBS Trust/PPO |
$250.93
|
| Rate for Payer: BCN Commercial |
$250.93
|
| Rate for Payer: Cash Price |
$244.46
|
| Rate for Payer: Cofinity Commercial |
$287.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.46
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$305.57
|
| Rate for Payer: Mclaren Commercial |
$275.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.73
|
| Rate for Payer: Nomi Health Commercial |
$250.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.90
|
|
|
HC INTRODUCER LONG
|
Facility
|
OP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$260.03 |
| Rate for Payer: Aetna Commercial |
$234.03
|
| Rate for Payer: Aetna Medicare |
$96.21
|
| Rate for Payer: ASR ASR |
$252.23
|
| Rate for Payer: BCBS Complete |
$104.01
|
| Rate for Payer: BCBS Trust/PPO |
$214.39
|
| Rate for Payer: BCN Commercial |
$214.39
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Commercial |
$244.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$252.23
|
| Rate for Payer: Healthscope Whirlpool |
$260.03
|
| Rate for Payer: Mclaren Commercial |
$234.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Nomi Health Commercial |
$213.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.84
|
| Rate for Payer: Priority Health Narrow Network |
$182.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.83
|
|
|
HC INTRODUCER LONG
|
Facility
|
IP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.02 |
| Max. Negotiated Rate |
$260.03 |
| Rate for Payer: Aetna Commercial |
$234.03
|
| Rate for Payer: ASR ASR |
$252.23
|
| Rate for Payer: BCBS Trust/PPO |
$213.54
|
| Rate for Payer: BCN Commercial |
$213.54
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Commercial |
$244.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$252.23
|
| Rate for Payer: Healthscope Whirlpool |
$260.03
|
| Rate for Payer: Mclaren Commercial |
$234.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Nomi Health Commercial |
$213.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.83
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$96.57 |
| Rate for Payer: Aetna Commercial |
$86.91
|
| Rate for Payer: ASR ASR |
$93.67
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$90.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$93.67
|
| Rate for Payer: Healthscope Whirlpool |
$96.57
|
| Rate for Payer: Mclaren Commercial |
$86.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Nomi Health Commercial |
$79.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.98
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
OP
|
$96.57
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$96.57 |
| Rate for Payer: Aetna Commercial |
$86.91
|
| Rate for Payer: Aetna Medicare |
$35.73
|
| Rate for Payer: ASR ASR |
$93.67
|
| Rate for Payer: BCBS Complete |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$79.62
|
| Rate for Payer: BCN Commercial |
$79.62
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$90.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$93.67
|
| Rate for Payer: Healthscope Whirlpool |
$96.57
|
| Rate for Payer: Mclaren Commercial |
$86.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Nomi Health Commercial |
$79.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.61
|
| Rate for Payer: Priority Health Narrow Network |
$67.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.98
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
OP
|
$3,526.75
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,472.25 |
| Max. Negotiated Rate |
$8,280.91 |
| Rate for Payer: Aetna Commercial |
$3,174.07
|
| Rate for Payer: Aetna Medicare |
$5,342.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: ASR ASR |
$3,420.95
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,907.81
|
| Rate for Payer: BCN Commercial |
$2,907.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Commercial |
$3,315.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$3,420.95
|
| Rate for Payer: Healthscope Whirlpool |
$3,526.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,342.52
|
| Rate for Payer: Mclaren Commercial |
$3,174.07
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$2,934.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Nomi Health Commercial |
$2,891.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,876.77
|
| Rate for Payer: PHP Medicaid |
$2,863.59
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,090.14
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Narrow Network |
$2,472.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,103.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$8,280.91
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP DNSP |
$5,342.52
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
IP
|
$3,526.75
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,645.06 |
| Max. Negotiated Rate |
$3,526.75 |
| Rate for Payer: Aetna Commercial |
$3,174.07
|
| Rate for Payer: ASR ASR |
$3,420.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,896.17
|
| Rate for Payer: BCN Commercial |
$2,896.17
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Commercial |
$3,315.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Healthscope Commercial |
$3,420.95
|
| Rate for Payer: Healthscope Whirlpool |
$3,526.75
|
| Rate for Payer: Mclaren Commercial |
$3,174.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Nomi Health Commercial |
$2,891.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,103.54
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
IP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$41.77 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: ASR ASR |
$40.52
|
| Rate for Payer: BCBS Trust/PPO |
$34.30
|
| Rate for Payer: BCN Commercial |
$34.30
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$39.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$40.52
|
| Rate for Payer: Healthscope Whirlpool |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$37.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: Nomi Health Commercial |
$34.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.76
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
OP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$41.77 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare |
$15.45
|
| Rate for Payer: ASR ASR |
$40.52
|
| Rate for Payer: BCBS Complete |
$16.71
|
| Rate for Payer: BCBS Trust/PPO |
$34.44
|
| Rate for Payer: BCN Commercial |
$34.44
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$39.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$40.52
|
| Rate for Payer: Healthscope Whirlpool |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$37.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: Nomi Health Commercial |
$34.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.60
|
| Rate for Payer: Priority Health Narrow Network |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.76
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$896.25 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna Commercial |
$1,075.50
|
| Rate for Payer: ASR ASR |
$1,159.15
|
| Rate for Payer: BCBS Trust/PPO |
$981.33
|
| Rate for Payer: BCN Commercial |
$981.33
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,123.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,159.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.00
|
| Rate for Payer: Mclaren Commercial |
$1,075.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Nomi Health Commercial |
$979.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$896.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.60
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.15 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna Commercial |
$1,075.50
|
| Rate for Payer: Aetna Medicare |
$442.15
|
| Rate for Payer: ASR ASR |
$1,159.15
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: BCBS Trust/PPO |
$985.28
|
| Rate for Payer: BCN Commercial |
$985.28
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,123.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,159.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.00
|
| Rate for Payer: Mclaren Commercial |
$1,075.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$956.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Nomi Health Commercial |
$979.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$896.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,047.06
|
| Rate for Payer: Priority Health Narrow Network |
$837.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.60
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: Aetna Commercial |
$146.07
|
| Rate for Payer: ASR ASR |
$157.43
|
| Rate for Payer: BCBS Trust/PPO |
$133.28
|
| Rate for Payer: BCN Commercial |
$133.28
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$152.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$157.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.30
|
| Rate for Payer: Mclaren Commercial |
$146.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.82
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.05 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: Aetna Commercial |
$146.07
|
| Rate for Payer: Aetna Medicare |
$60.05
|
| Rate for Payer: ASR ASR |
$157.43
|
| Rate for Payer: BCBS Complete |
$64.92
|
| Rate for Payer: BCBS Trust/PPO |
$133.82
|
| Rate for Payer: BCN Commercial |
$133.82
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$152.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$157.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.30
|
| Rate for Payer: Mclaren Commercial |
$146.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.82
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: BCBS Trust/PPO |
$277.15
|
| Rate for Payer: BCN Commercial |
$277.15
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$327.38
|
| Rate for Payer: Healthscope Whirlpool |
$337.50
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.88 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: Aetna Medicare |
$124.88
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$278.27
|
| Rate for Payer: BCN Commercial |
$278.27
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$327.38
|
| Rate for Payer: Healthscope Whirlpool |
$337.50
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$236.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.51 |
| Max. Negotiated Rate |
$485.16 |
| Rate for Payer: Aetna Commercial |
$436.64
|
| Rate for Payer: Aetna Medicare |
$179.51
|
| Rate for Payer: ASR ASR |
$470.61
|
| Rate for Payer: BCBS Complete |
$194.06
|
| Rate for Payer: BCBS Trust/PPO |
$400.01
|
| Rate for Payer: BCN Commercial |
$400.01
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$456.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$470.61
|
| Rate for Payer: Healthscope Whirlpool |
$485.16
|
| Rate for Payer: Mclaren Commercial |
$436.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Nomi Health Commercial |
$397.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$425.10
|
| Rate for Payer: Priority Health Narrow Network |
$340.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.94
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.87 |
| Max. Negotiated Rate |
$485.16 |
| Rate for Payer: Aetna Commercial |
$436.64
|
| Rate for Payer: ASR ASR |
$470.61
|
| Rate for Payer: BCBS Trust/PPO |
$398.41
|
| Rate for Payer: BCN Commercial |
$398.41
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$456.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$470.61
|
| Rate for Payer: Healthscope Whirlpool |
$485.16
|
| Rate for Payer: Mclaren Commercial |
$436.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Nomi Health Commercial |
$397.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.94
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$24.11
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$12.92
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.90
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$137.52
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.11
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$12.61
|
| Rate for Payer: UHCCP DNSP |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.61
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$725.79 |
| Max. Negotiated Rate |
$5,545.36 |
| Rate for Payer: Aetna Commercial |
$4,990.82
|
| Rate for Payer: Aetna Medicare |
$1,387.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,734.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,734.67
|
| Rate for Payer: ASR ASR |
$5,379.00
|
| Rate for Payer: BCBS Complete |
$762.15
|
| Rate for Payer: BCBS MAPPO |
$1,387.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,572.15
|
| Rate for Payer: BCN Commercial |
$4,572.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,387.74
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Commercial |
$5,212.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,387.74
|
| Rate for Payer: Healthscope Commercial |
$5,379.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,545.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,387.74
|
| Rate for Payer: Mclaren Commercial |
$4,990.82
|
| Rate for Payer: Mclaren Medicaid |
$1,387.74
|
| Rate for Payer: Mclaren Medicare |
$1,387.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.13
|
| Rate for Payer: Meridian Medicaid |
$762.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,595.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,526.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Nomi Health Commercial |
$4,547.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: PACE Medicare |
$1,318.35
|
| Rate for Payer: PACE SWMI |
$1,387.74
|
| Rate for Payer: PHP Commercial |
$1,526.51
|
| Rate for Payer: PHP Medicaid |
$743.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,387.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,643.84
|
| Rate for Payer: Priority Health Medicare |
$1,387.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,115.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,387.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,879.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,387.74
|
| Rate for Payer: UHC Exchange |
$2,151.00
|
| Rate for Payer: UHC Medicaid |
$725.79
|
| Rate for Payer: UHCCP DNSP |
$1,387.74
|
| Rate for Payer: UHCCP Medicaid |
$725.79
|
| Rate for Payer: VA VA |
$1,387.74
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,159.02 |
| Max. Negotiated Rate |
$5,545.36 |
| Rate for Payer: Aetna Commercial |
$4,990.82
|
| Rate for Payer: ASR ASR |
$5,379.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,553.85
|
| Rate for Payer: BCN Commercial |
$4,553.85
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Commercial |
$5,212.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Healthscope Commercial |
$5,379.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,545.36
|
| Rate for Payer: Mclaren Commercial |
$4,990.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Nomi Health Commercial |
$4,547.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,879.92
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$489.82 |
| Max. Negotiated Rate |
$1,323.85 |
| Rate for Payer: Aetna Commercial |
$1,191.46
|
| Rate for Payer: Aetna Medicare |
$489.82
|
| Rate for Payer: ASR ASR |
$1,284.13
|
| Rate for Payer: BCBS Complete |
$529.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.51
|
| Rate for Payer: BCN Commercial |
$1,091.51
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Commercial |
$1,244.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Healthscope Commercial |
$1,284.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,323.85
|
| Rate for Payer: Mclaren Commercial |
$1,191.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,059.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,159.96
|
| Rate for Payer: Priority Health Narrow Network |
$928.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,164.99
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$992.89 |
| Max. Negotiated Rate |
$1,323.85 |
| Rate for Payer: Aetna Commercial |
$1,191.46
|
| Rate for Payer: ASR ASR |
$1,284.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,087.15
|
| Rate for Payer: BCN Commercial |
$1,087.15
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Commercial |
$1,244.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Healthscope Commercial |
$1,284.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,323.85
|
| Rate for Payer: Mclaren Commercial |
$1,191.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,164.99
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$190.81 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: Aetna Medicare |
$70.60
|
| Rate for Payer: ASR ASR |
$185.09
|
| Rate for Payer: BCBS Complete |
$76.32
|
| Rate for Payer: BCBS Trust/PPO |
$157.32
|
| Rate for Payer: BCN Commercial |
$157.32
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Commercial |
$179.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Healthscope Commercial |
$185.09
|
| Rate for Payer: Healthscope Whirlpool |
$190.81
|
| Rate for Payer: Mclaren Commercial |
$171.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Nomi Health Commercial |
$156.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.91
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$143.11 |
| Max. Negotiated Rate |
$190.81 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: ASR ASR |
$185.09
|
| Rate for Payer: BCBS Trust/PPO |
$156.69
|
| Rate for Payer: BCN Commercial |
$156.69
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Commercial |
$179.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Healthscope Commercial |
$185.09
|
| Rate for Payer: Healthscope Whirlpool |
$190.81
|
| Rate for Payer: Mclaren Commercial |
$171.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Nomi Health Commercial |
$156.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.91
|
|
