|
HC REVAS DES/CABG INITIAL
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,348.94 |
| 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 |
$8,306.60
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| 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 REVAS DES/CABG INITIAL
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
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 MI/DES
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Complete |
$11,636.61
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| 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 |
$25,600.54
|
|
|
HC REVAS MI/DES
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,364.06 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
|
|
HC REVAS MI/STENT
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,364.06 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
|
|
HC REVAS MI/STENT
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Complete |
$11,636.61
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| 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 |
$25,600.54
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$15,710.04
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,997.03 |
| Max. Negotiated Rate |
$15,710.04 |
| Rate for Payer: Aetna Commercial |
$14,139.04
|
| Rate for Payer: ASR ASR |
$15,238.74
|
| Rate for Payer: BCBS Trust/PPO |
$12,179.99
|
| Rate for Payer: BCN Commercial |
$12,179.99
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cofinity Commercial |
$14,767.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,568.03
|
| Rate for Payer: Healthscope Commercial |
$15,710.04
|
| Rate for Payer: Healthscope Whirlpool |
$15,238.74
|
| Rate for Payer: Mclaren Commercial |
$14,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,353.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,997.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,824.84
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$15,710.04
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,325.31 |
| Max. Negotiated Rate |
$15,710.04 |
| Rate for Payer: Aetna Commercial |
$14,139.04
|
| 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 |
$15,238.74
|
| Rate for Payer: BCBS Complete |
$3,491.88
|
| Rate for Payer: BCBS MAPPO |
$6,079.17
|
| Rate for Payer: BCBS Trust/PPO |
$12,179.99
|
| Rate for Payer: BCN Commercial |
$12,179.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,079.17
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cofinity Commercial |
$14,767.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,568.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,079.17
|
| Rate for Payer: Healthscope Commercial |
$15,710.04
|
| Rate for Payer: Healthscope Whirlpool |
$15,238.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,079.17
|
| Rate for Payer: Mclaren Commercial |
$14,139.04
|
| 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 |
$13,353.53
|
| 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 |
$10,997.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,296.14
|
| Rate for Payer: Priority Health Medicare |
$6,079.17
|
| Rate for Payer: Priority Health Narrow Network |
$11,154.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6,079.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,824.84
|
| Rate for Payer: UHC Medicare Advantage |
$6,261.55
|
| Rate for Payer: VA VA |
$6,079.17
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
OP
|
$7,263.14
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$7,263.14 |
| Rate for Payer: Aetna Commercial |
$6,536.83
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: ASR ASR |
$7,045.25
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,631.11
|
| Rate for Payer: BCN Commercial |
$5,631.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cofinity Commercial |
$6,827.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,810.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$7,263.14
|
| Rate for Payer: Healthscope Whirlpool |
$7,045.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$6,536.83
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,173.67
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,084.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,609.46
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$5,156.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,391.56
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
IP
|
$7,263.14
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,084.20 |
| Max. Negotiated Rate |
$7,263.14 |
| Rate for Payer: Aetna Commercial |
$6,536.83
|
| Rate for Payer: ASR ASR |
$7,045.25
|
| Rate for Payer: BCBS Trust/PPO |
$5,631.11
|
| Rate for Payer: BCN Commercial |
$5,631.11
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cofinity Commercial |
$6,827.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,810.51
|
| Rate for Payer: Healthscope Commercial |
$7,263.14
|
| Rate for Payer: Healthscope Whirlpool |
$7,045.25
|
| Rate for Payer: Mclaren Commercial |
$6,536.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,173.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,084.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,391.56
|
|
|
HC RF ABLATION LIVER TUMOR
|
Facility
|
OP
|
$5,770.46
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$6,411.01 |
| Rate for Payer: Aetna Commercial |
$5,193.41
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: ASR ASR |
$5,597.35
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,473.84
|
| Rate for Payer: BCN Commercial |
$4,473.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cofinity Commercial |
$5,424.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,616.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$5,770.46
|
| Rate for Payer: Healthscope Whirlpool |
$5,597.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$5,193.41
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,904.89
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,039.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,251.12
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,097.03
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,078.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
HC RF ABLATION LIVER TUMOR
|
Facility
|
IP
|
$5,770.46
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,039.32 |
| Max. Negotiated Rate |
$5,770.46 |
| Rate for Payer: Aetna Commercial |
$5,193.41
|
| Rate for Payer: ASR ASR |
$5,597.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,473.84
|
| Rate for Payer: BCN Commercial |
$4,473.84
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cofinity Commercial |
$5,424.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,616.37
|
| Rate for Payer: Healthscope Commercial |
$5,770.46
|
| Rate for Payer: Healthscope Whirlpool |
$5,597.35
|
| Rate for Payer: Mclaren Commercial |
$5,193.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,904.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,039.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,078.00
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
OP
|
$2,630.61
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$938.78 |
| Max. Negotiated Rate |
$2,630.61 |
| Rate for Payer: Aetna Commercial |
$2,367.55
|
| Rate for Payer: Aetna Medicare |
$1,716.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: ASR ASR |
$2,551.69
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.51
|
| Rate for Payer: BCN Commercial |
$2,039.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$2,472.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,104.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$2,630.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,551.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$2,367.55
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$1,887.85
|
| Rate for Payer: PHP Medicaid |
$938.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.50
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,471.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,314.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
IP
|
$2,630.61
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,841.43 |
| Max. Negotiated Rate |
$2,630.61 |
| Rate for Payer: Aetna Commercial |
$2,367.55
|
| Rate for Payer: ASR ASR |
$2,551.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.51
|
| Rate for Payer: BCN Commercial |
$2,039.51
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$2,472.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,104.49
|
| Rate for Payer: Healthscope Commercial |
$2,630.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,551.69
|
| Rate for Payer: Mclaren Commercial |
$2,367.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,314.94
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
IP
|
$1,753.45
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,227.42 |
| Max. Negotiated Rate |
$1,753.45 |
| Rate for Payer: Aetna Commercial |
$1,578.10
|
| Rate for Payer: ASR ASR |
$1,700.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.45
|
| Rate for Payer: BCN Commercial |
$1,359.45
|
| Rate for Payer: Cash Price |
$1,402.76
|
| Rate for Payer: Cofinity Commercial |
$1,648.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.76
|
| Rate for Payer: Healthscope Commercial |
$1,753.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,700.85
|
| Rate for Payer: Mclaren Commercial |
$1,578.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,490.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,543.04
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
OP
|
$1,753.45
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.38 |
| Max. Negotiated Rate |
$1,753.45 |
| Rate for Payer: Aetna Commercial |
$1,578.10
|
| Rate for Payer: ASR ASR |
$1,700.85
|
| Rate for Payer: BCBS Complete |
$701.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.45
|
| Rate for Payer: BCN Commercial |
$1,359.45
|
| Rate for Payer: Cash Price |
$1,402.76
|
| Rate for Payer: Cofinity Commercial |
$1,648.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.76
|
| Rate for Payer: Healthscope Commercial |
$1,753.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,700.85
|
| Rate for Payer: Mclaren Commercial |
$1,578.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,490.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,595.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,244.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,543.04
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$69.79 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.09
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.67
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.67
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.10
|
| Rate for Payer: Mclaren Medicare |
$5.67
|
| Rate for Payer: Meridian Medicaid |
$3.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.39
|
| Rate for Payer: PACE SWMI |
$5.67
|
| Rate for Payer: PHP Commercial |
$6.24
|
| Rate for Payer: PHP Medicaid |
$3.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.79
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow Network |
$55.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$5.84
|
| Rate for Payer: VA VA |
$5.67
|
|
|
HC RHOGAM
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.89 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$250.57
|
| Rate for Payer: ASR ASR |
$270.06
|
| Rate for Payer: BCBS Trust/PPO |
$215.85
|
| Rate for Payer: BCN Commercial |
$215.85
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$261.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.00
|
|
|
HC RHOGAM
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$250.57
|
| Rate for Payer: ASR ASR |
$270.06
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: BCBS Trust/PPO |
$215.85
|
| Rate for Payer: BCN Commercial |
$215.85
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$261.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.35
|
| Rate for Payer: Priority Health Narrow Network |
$197.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.00
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
OP
|
$3,693.37
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$578.66 |
| Max. Negotiated Rate |
$3,693.37 |
| Rate for Payer: Aetna Commercial |
$3,324.03
|
| Rate for Payer: Aetna Medicare |
$1,057.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,322.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,322.35
|
| Rate for Payer: ASR ASR |
$3,582.57
|
| Rate for Payer: BCBS Complete |
$607.65
|
| Rate for Payer: BCBS MAPPO |
$1,057.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.47
|
| Rate for Payer: BCN Commercial |
$2,863.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.88
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,471.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.88
|
| Rate for Payer: Healthscope Commercial |
$3,693.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,057.88
|
| Rate for Payer: Mclaren Commercial |
$3,324.03
|
| Rate for Payer: Mclaren Medicaid |
$578.66
|
| Rate for Payer: Mclaren Medicare |
$1,057.88
|
| Rate for Payer: Meridian Medicaid |
$607.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,110.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PACE Medicare |
$1,004.99
|
| Rate for Payer: PACE SWMI |
$1,057.88
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: PHP Medicaid |
$578.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,360.97
|
| Rate for Payer: Priority Health Medicare |
$1,057.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,622.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,089.62
|
| Rate for Payer: VA VA |
$1,057.88
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
IP
|
$3,693.37
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,585.36 |
| Max. Negotiated Rate |
$3,693.37 |
| Rate for Payer: Aetna Commercial |
$3,324.03
|
| Rate for Payer: ASR ASR |
$3,582.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.47
|
| Rate for Payer: BCN Commercial |
$2,863.47
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,471.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.70
|
| Rate for Payer: Healthscope Commercial |
$3,693.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.57
|
| Rate for Payer: Mclaren Commercial |
$3,324.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.17
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: ASR ASR |
$107.67
|
| Rate for Payer: BCBS Trust/PPO |
$86.06
|
| Rate for Payer: BCN Commercial |
$86.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$111.00
|
| Rate for Payer: Healthscope Whirlpool |
$107.67
|
| Rate for Payer: Mclaren Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.68
|
|
