|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$598.05 |
| Max. Negotiated Rate |
$1,495.13 |
| Rate for Payer: Aetna Commercial |
$1,345.62
|
| Rate for Payer: ASR ASR |
$1,450.28
|
| Rate for Payer: BCBS Complete |
$598.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.17
|
| Rate for Payer: BCN Commercial |
$1,159.17
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,405.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Healthscope Commercial |
$1,495.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,450.28
|
| Rate for Payer: Mclaren Commercial |
$1,345.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,360.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,315.71
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,046.59 |
| Max. Negotiated Rate |
$1,495.13 |
| Rate for Payer: Aetna Commercial |
$1,345.62
|
| Rate for Payer: ASR ASR |
$1,450.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.17
|
| Rate for Payer: BCN Commercial |
$1,159.17
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,405.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Healthscope Commercial |
$1,495.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,450.28
|
| Rate for Payer: Mclaren Commercial |
$1,345.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,315.71
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$20.28 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$20.28
|
| Rate for Payer: Healthscope Whirlpool |
$19.67
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.45
|
| Rate for Payer: Priority Health Narrow Network |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$20.28 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$20.28
|
| Rate for Payer: Healthscope Whirlpool |
$19.67
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$709.30 |
| Max. Negotiated Rate |
$1,013.28 |
| Rate for Payer: Aetna Commercial |
$911.95
|
| Rate for Payer: ASR ASR |
$982.88
|
| Rate for Payer: BCBS Trust/PPO |
$785.60
|
| Rate for Payer: BCN Commercial |
$785.60
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$952.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Healthscope Commercial |
$1,013.28
|
| Rate for Payer: Healthscope Whirlpool |
$982.88
|
| Rate for Payer: Mclaren Commercial |
$911.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.69
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$1,013.28 |
| Rate for Payer: Aetna Commercial |
$911.95
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: ASR ASR |
$982.88
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$785.60
|
| Rate for Payer: BCN Commercial |
$785.60
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$952.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$1,013.28
|
| Rate for Payer: Healthscope Whirlpool |
$982.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.59
|
| Rate for Payer: Mclaren Commercial |
$911.95
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicaid |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.08
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$719.43
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.69
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: VA VA |
$189.59
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: ASR ASR |
$169.75
|
| Rate for Payer: BCBS Trust/PPO |
$135.68
|
| Rate for Payer: BCN Commercial |
$135.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.75
|
| Rate for Payer: Mclaren Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.00
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: ASR ASR |
$169.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$135.68
|
| Rate for Payer: BCN Commercial |
$135.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.75
|
| Rate for Payer: Mclaren Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.25
|
| Rate for Payer: Priority Health Narrow Network |
$124.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.00
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Aetna Commercial |
$48.16
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.49
|
| Rate for Payer: BCN Commercial |
$41.49
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$50.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$53.51
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Mclaren Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.09
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Aetna Commercial |
$48.16
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.49
|
| Rate for Payer: BCN Commercial |
$41.49
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$50.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$53.51
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Mclaren Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.69
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.09
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,682.15 |
| Max. Negotiated Rate |
$5,063.57 |
| Rate for Payer: Aetna Commercial |
$4,557.21
|
| Rate for Payer: Aetna Medicare |
$3,075.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: ASR ASR |
$4,911.66
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,925.79
|
| Rate for Payer: BCN Commercial |
$3,925.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$4,759.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,050.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$5,063.57
|
| Rate for Payer: Healthscope Whirlpool |
$4,911.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,075.22
|
| Rate for Payer: Mclaren Commercial |
$4,557.21
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$3,382.74
|
| Rate for Payer: PHP Medicaid |
$1,682.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,607.85
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$3,595.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,455.94
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,544.50 |
| Max. Negotiated Rate |
$5,063.57 |
| Rate for Payer: Aetna Commercial |
$4,557.21
|
| Rate for Payer: ASR ASR |
$4,911.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,925.79
|
| Rate for Payer: BCN Commercial |
$3,925.79
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$4,759.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,050.86
|
| Rate for Payer: Healthscope Commercial |
$5,063.57
|
| Rate for Payer: Healthscope Whirlpool |
$4,911.66
|
| Rate for Payer: Mclaren Commercial |
$4,557.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,455.94
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.97
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$50.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
OP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,325.31 |
| Max. Negotiated Rate |
$13,824.57 |
| Rate for Payer: Aetna Commercial |
$12,442.11
|
| Rate for Payer: Aetna Medicare |
$6,079.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,598.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,598.96
|
| Rate for Payer: ASR ASR |
$13,409.83
|
| Rate for Payer: BCBS Complete |
$3,491.88
|
| Rate for Payer: BCBS MAPPO |
$6,079.17
|
| Rate for Payer: BCBS Trust/PPO |
$10,718.19
|
| Rate for Payer: BCN Commercial |
$10,718.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,079.17
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$12,995.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,059.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,079.17
|
| Rate for Payer: Healthscope Commercial |
$13,824.57
|
| Rate for Payer: Healthscope Whirlpool |
$13,409.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,079.17
|
| Rate for Payer: Mclaren Commercial |
$12,442.11
|
| Rate for Payer: Mclaren Medicaid |
$3,325.31
|
| Rate for Payer: Mclaren Medicare |
$6,079.17
|
| Rate for Payer: Meridian Medicaid |
$3,491.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,383.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,991.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: PACE Medicare |
$5,775.21
|
| Rate for Payer: PACE SWMI |
$6,079.17
|
| Rate for Payer: PHP Commercial |
$6,687.09
|
| Rate for Payer: PHP Medicaid |
$3,325.31
|
| Rate for Payer: PHP Medicare Advantage |
$6,079.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,325.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,580.36
|
| Rate for Payer: Priority Health Medicare |
$6,079.17
|
| Rate for Payer: Priority Health Narrow Network |
$9,815.44
|
| Rate for Payer: Railroad Medicare Medicare |
$6,079.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,165.62
|
| Rate for Payer: UHC Medicare Advantage |
$6,261.55
|
| Rate for Payer: VA VA |
$6,079.17
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
IP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,677.20 |
| Max. Negotiated Rate |
$13,824.57 |
| Rate for Payer: Aetna Commercial |
$12,442.11
|
| Rate for Payer: ASR ASR |
$13,409.83
|
| Rate for Payer: BCBS Trust/PPO |
$10,718.19
|
| Rate for Payer: BCN Commercial |
$10,718.19
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$12,995.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,059.66
|
| Rate for Payer: Healthscope Commercial |
$13,824.57
|
| Rate for Payer: Healthscope Whirlpool |
$13,409.83
|
| Rate for Payer: Mclaren Commercial |
$12,442.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,165.62
|
|
|
HC PERCLOSE
|
Facility
|
IP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.12 |
| Max. Negotiated Rate |
$1,031.60 |
| Rate for Payer: Aetna Commercial |
$928.44
|
| Rate for Payer: ASR ASR |
$1,000.65
|
| Rate for Payer: BCBS Trust/PPO |
$799.80
|
| Rate for Payer: BCN Commercial |
$799.80
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$969.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.28
|
| Rate for Payer: Healthscope Commercial |
$1,031.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.65
|
| Rate for Payer: Mclaren Commercial |
$928.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.81
|
|
|
HC PERCLOSE
|
Facility
|
OP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.64 |
| Max. Negotiated Rate |
$1,031.60 |
| Rate for Payer: Aetna Commercial |
$928.44
|
| Rate for Payer: ASR ASR |
$1,000.65
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: BCBS Trust/PPO |
$799.80
|
| Rate for Payer: BCN Commercial |
$799.80
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$969.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.28
|
| Rate for Payer: Healthscope Commercial |
$1,031.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.65
|
| Rate for Payer: Mclaren Commercial |
$928.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.76
|
| Rate for Payer: Priority Health Narrow Network |
$732.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.81
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,779.05 |
| Max. Negotiated Rate |
$6,381.71 |
| Rate for Payer: Aetna Commercial |
$5,743.54
|
| Rate for Payer: Aetna Medicare |
$5,080.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: ASR ASR |
$6,190.26
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,947.74
|
| Rate for Payer: BCN Commercial |
$4,947.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$5,998.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,105.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Healthscope Commercial |
$6,381.71
|
| Rate for Payer: Healthscope Whirlpool |
$6,190.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,080.53
|
| Rate for Payer: Mclaren Commercial |
$5,743.54
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Commercial |
$5,588.58
|
| Rate for Payer: PHP Medicaid |
$2,779.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,807.36
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,531.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,615.90
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,467.20 |
| Max. Negotiated Rate |
$6,381.71 |
| Rate for Payer: Aetna Commercial |
$5,743.54
|
| Rate for Payer: ASR ASR |
$6,190.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,947.74
|
| Rate for Payer: BCN Commercial |
$4,947.74
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$5,998.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,105.37
|
| Rate for Payer: Healthscope Commercial |
$6,381.71
|
| Rate for Payer: Healthscope Whirlpool |
$6,190.26
|
| Rate for Payer: Mclaren Commercial |
$5,743.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,615.90
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,141.94 |
| Max. Negotiated Rate |
$17,345.63 |
| Rate for Payer: Aetna Commercial |
$15,611.07
|
| Rate for Payer: ASR ASR |
$16,825.26
|
| Rate for Payer: BCBS Trust/PPO |
$13,448.07
|
| Rate for Payer: BCN Commercial |
$13,448.07
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$16,304.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,876.50
|
| Rate for Payer: Healthscope Commercial |
$17,345.63
|
| Rate for Payer: Healthscope Whirlpool |
$16,825.26
|
| Rate for Payer: Mclaren Commercial |
$15,611.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,264.15
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$17,345.63 |
| Rate for Payer: Aetna Commercial |
$15,611.07
|
| Rate for Payer: Aetna Medicare |
$9,778.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: ASR ASR |
$16,825.26
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,448.07
|
| Rate for Payer: BCN Commercial |
$13,448.07
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$16,304.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,876.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$17,345.63
|
| Rate for Payer: Healthscope Whirlpool |
$16,825.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$15,611.07
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$10,756.56
|
| Rate for Payer: PHP Medicaid |
$5,348.94
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,784.52
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,315.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,264.15
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC PERC THROMBECT OR INF W STENT PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$27,544.40
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
36100530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19,281.08 |
| Max. Negotiated Rate |
$27,544.40 |
| Rate for Payer: Aetna Commercial |
$24,789.96
|
| Rate for Payer: ASR ASR |
$26,718.07
|
| Rate for Payer: BCBS Trust/PPO |
$21,355.17
|
| Rate for Payer: BCN Commercial |
$21,355.17
|
| Rate for Payer: Cash Price |
$22,035.52
|
| Rate for Payer: Cofinity Commercial |
$25,891.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,035.52
|
| Rate for Payer: Healthscope Commercial |
$27,544.40
|
| Rate for Payer: Healthscope Whirlpool |
$26,718.07
|
| Rate for Payer: Mclaren Commercial |
$24,789.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,412.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,281.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24,239.07
|
|
