|
HC RESP VIRAL PANEL CHLAMYDIA
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
30600186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC RESP VIRAL PANEL MYCOPLASMA
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600185
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$43.45
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC RESP VIRAL PANEL MYCOPLASMA
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600185
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$474.48
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
|
|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$227.98 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: BCBS Complete |
$239.40
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$474.48
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$227.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Medicaid |
$239.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$520.20
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$227.98
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.92
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$434.52
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Medicare Advantage |
$429.28
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
OP
|
$18.48
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: ASR ASR |
$17.93
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$18.48
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.82
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.26
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
IP
|
$18.48
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: ASR ASR |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$18.48
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.26
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| 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 |
$262.19
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| 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 |
$229.76
|
| 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 |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.21 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| Rate for Payer: ASR ASR |
$262.19
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna Commercial |
$36.63
|
| Rate for Payer: ASR ASR |
$39.48
|
| Rate for Payer: BCBS Trust/PPO |
$31.55
|
| Rate for Payer: BCN Commercial |
$31.55
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Healthscope Whirlpool |
$39.48
|
| Rate for Payer: Mclaren Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.82
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna Commercial |
$36.63
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: ASR ASR |
$39.48
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$31.55
|
| Rate for Payer: BCN Commercial |
$31.55
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Healthscope Whirlpool |
$39.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$36.63
|
| Rate for Payer: Mclaren Medicaid |
$3.05
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.60
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$6.13
|
| Rate for Payer: PHP Medicaid |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.04
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$28.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
IP
|
$18,972.73
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,280.91 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,075.46
|
| Rate for Payer: ASR ASR |
$18,403.55
|
| Rate for Payer: BCBS Trust/PPO |
$14,709.56
|
| Rate for Payer: BCN Commercial |
$14,709.56
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$17,834.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,178.18
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Healthscope Whirlpool |
$18,403.55
|
| Rate for Payer: Mclaren Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,696.00
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
OP
|
$18,972.73
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,075.46
|
| Rate for Payer: ASR ASR |
$18,403.55
|
| Rate for Payer: BCBS Complete |
$7,589.09
|
| Rate for Payer: BCBS Trust/PPO |
$14,709.56
|
| Rate for Payer: BCN Commercial |
$14,709.56
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$17,834.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,178.18
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Healthscope Whirlpool |
$18,403.55
|
| Rate for Payer: Mclaren Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,306.60
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,696.00
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
IP
|
$18,972.73
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,280.91 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,075.46
|
| Rate for Payer: ASR ASR |
$18,403.55
|
| Rate for Payer: BCBS Trust/PPO |
$14,709.56
|
| Rate for Payer: BCN Commercial |
$14,709.56
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$17,834.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,178.18
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Healthscope Whirlpool |
$18,403.55
|
| Rate for Payer: Mclaren Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,696.00
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
OP
|
$18,972.73
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,075.46
|
| Rate for Payer: ASR ASR |
$18,403.55
|
| Rate for Payer: BCBS Complete |
$7,589.09
|
| Rate for Payer: BCBS Trust/PPO |
$14,709.56
|
| Rate for Payer: BCN Commercial |
$14,709.56
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$17,834.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,178.18
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Healthscope Whirlpool |
$18,403.55
|
| Rate for Payer: Mclaren Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,696.00
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,109.14 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,010.80 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| Rate for Payer: ASR ASR |
$27,729.25
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| 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 |
$27,729.25
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| 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 |
$24,298.83
|
| 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 |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
OP
|
$11,594.76
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,116.33 |
| Max. Negotiated Rate |
$19,483.22 |
| Rate for Payer: Aetna Commercial |
$10,435.28
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$11,246.92
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$8,989.42
|
| Rate for Payer: BCN Commercial |
$8,989.42
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cofinity Commercial |
$10,899.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,275.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$11,594.76
|
| Rate for Payer: Healthscope Whirlpool |
$11,246.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$10,435.28
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,855.55
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,116.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,551.23
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$8,232.28
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,203.39
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$11,594.76
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,116.33 |
| Max. Negotiated Rate |
$11,594.76 |
| Rate for Payer: Aetna Commercial |
$10,435.28
|
| Rate for Payer: ASR ASR |
$11,246.92
|
| Rate for Payer: BCBS Trust/PPO |
$8,989.42
|
| Rate for Payer: BCN Commercial |
$8,989.42
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cofinity Commercial |
$10,899.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,275.81
|
| Rate for Payer: Healthscope Commercial |
$11,594.76
|
| Rate for Payer: Healthscope Whirlpool |
$11,246.92
|
| Rate for Payer: Mclaren Commercial |
$10,435.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,855.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,116.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,203.39
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
IP
|
$12,754.23
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,927.96 |
| Max. Negotiated Rate |
$12,754.23 |
| Rate for Payer: Aetna Commercial |
$11,478.81
|
| Rate for Payer: ASR ASR |
$12,371.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,888.35
|
| Rate for Payer: BCN Commercial |
$9,888.35
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cofinity Commercial |
$11,988.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,203.38
|
| Rate for Payer: Healthscope Commercial |
$12,754.23
|
| Rate for Payer: Healthscope Whirlpool |
$12,371.60
|
| Rate for Payer: Mclaren Commercial |
$11,478.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,841.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,927.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,223.72
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
OP
|
$12,754.23
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$12,754.23 |
| Rate for Payer: Aetna Commercial |
$11,478.81
|
| 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 |
$12,371.60
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,888.35
|
| Rate for Payer: BCN Commercial |
$9,888.35
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cofinity Commercial |
$11,988.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,203.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$12,754.23
|
| Rate for Payer: Healthscope Whirlpool |
$12,371.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$11,478.81
|
| 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 |
$10,841.10
|
| 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 |
$8,927.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,606.35
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$9,055.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,223.72
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,306.60
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,109.14 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
