|
HC MECONIUM THC CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.78
|
| Rate for Payer: Priority Health Narrow Network |
$82.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
OP
|
$65.14
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$32.57
|
| Rate for Payer: ASR ASR |
$63.19
|
| Rate for Payer: ASR Commercial |
$63.19
|
| Rate for Payer: BCBS Complete |
$26.06
|
| Rate for Payer: BCBS Trust/PPO |
$53.34
|
| Rate for Payer: BCN Commercial |
$50.50
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$65.14
|
| Rate for Payer: Healthscope Whirlpool |
$63.19
|
| Rate for Payer: Mclaren Commercial |
$58.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.37
|
| Rate for Payer: Nomi Health Commercial |
$53.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.08
|
| Rate for Payer: Priority Health Narrow Network |
$45.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.32
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
IP
|
$65.14
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: ASR ASR |
$63.19
|
| Rate for Payer: ASR Commercial |
$63.19
|
| Rate for Payer: BCBS Trust/PPO |
$53.08
|
| Rate for Payer: BCN Commercial |
$50.50
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$65.14
|
| Rate for Payer: Healthscope Whirlpool |
$63.19
|
| Rate for Payer: Mclaren Commercial |
$58.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.37
|
| Rate for Payer: Nomi Health Commercial |
$53.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.32
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
OP
|
$263.99
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$237.59
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$256.07
|
| Rate for Payer: ASR Commercial |
$256.07
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$216.18
|
| Rate for Payer: BCN Commercial |
$204.67
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cofinity Commercial |
$248.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$263.99
|
| Rate for Payer: Healthscope Whirlpool |
$256.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$237.59
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.39
|
| Rate for Payer: Nomi Health Commercial |
$216.47
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.31
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$185.06
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$263.99
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$263.99 |
| Rate for Payer: Aetna Commercial |
$237.59
|
| Rate for Payer: ASR ASR |
$256.07
|
| Rate for Payer: ASR Commercial |
$256.07
|
| Rate for Payer: BCBS Trust/PPO |
$215.13
|
| Rate for Payer: BCN Commercial |
$204.67
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cofinity Commercial |
$248.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.19
|
| Rate for Payer: Healthscope Commercial |
$263.99
|
| Rate for Payer: Healthscope Whirlpool |
$256.07
|
| Rate for Payer: Mclaren Commercial |
$237.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.39
|
| Rate for Payer: Nomi Health Commercial |
$216.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.31
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,181.95 |
| Max. Negotiated Rate |
$3,356.84 |
| Rate for Payer: Aetna Commercial |
$3,021.16
|
| Rate for Payer: ASR ASR |
$3,256.13
|
| Rate for Payer: ASR Commercial |
$3,256.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.49
|
| Rate for Payer: BCN Commercial |
$2,602.56
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$3,155.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,356.84
|
| Rate for Payer: Healthscope Whirlpool |
$3,256.13
|
| Rate for Payer: Mclaren Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,954.02
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$65.32 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: ASR Commercial |
$47.49
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$40.09
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$52.26
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: ASR Commercial |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.90
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,985.41 |
| Max. Negotiated Rate |
$29,963.52 |
| Rate for Payer: Aetna Commercial |
$26,967.17
|
| Rate for Payer: Aetna Medicare |
$14,981.76
|
| Rate for Payer: ASR ASR |
$29,064.61
|
| Rate for Payer: ASR Commercial |
$29,064.61
|
| Rate for Payer: BCBS Complete |
$11,985.41
|
| Rate for Payer: BCBS Trust/PPO |
$24,537.13
|
| Rate for Payer: BCN Commercial |
$23,230.72
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$28,165.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Healthscope Commercial |
$29,963.52
|
| Rate for Payer: Healthscope Whirlpool |
$29,064.61
|
| Rate for Payer: Mclaren Commercial |
$26,967.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: Nomi Health Commercial |
$24,570.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,254.04
|
| Rate for Payer: Priority Health Narrow Network |
$21,004.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,367.90
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,476.29 |
| Max. Negotiated Rate |
$29,963.52 |
| Rate for Payer: Aetna Commercial |
$26,967.17
|
| Rate for Payer: ASR ASR |
$29,064.61
|
| Rate for Payer: ASR Commercial |
$29,064.61
|
| Rate for Payer: BCBS Trust/PPO |
$24,417.27
|
| Rate for Payer: BCN Commercial |
$23,230.72
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$28,165.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Healthscope Commercial |
$29,963.52
|
| Rate for Payer: Healthscope Whirlpool |
$29,064.61
|
| Rate for Payer: Mclaren Commercial |
$26,967.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: Nomi Health Commercial |
$24,570.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,367.90
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,034.90 |
| Max. Negotiated Rate |
$6,207.54 |
| Rate for Payer: Aetna Commercial |
$5,586.79
|
| Rate for Payer: ASR ASR |
$6,021.31
|
| Rate for Payer: ASR Commercial |
$6,021.31
|
| Rate for Payer: BCBS Trust/PPO |
$5,058.52
|
| Rate for Payer: BCN Commercial |
$4,812.71
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$5,835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Healthscope Commercial |
$6,207.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,021.31
|
| Rate for Payer: Mclaren Commercial |
$5,586.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: Nomi Health Commercial |
$5,090.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,462.64
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,483.02 |
| Max. Negotiated Rate |
$6,207.54 |
| Rate for Payer: Aetna Commercial |
$5,586.79
|
| Rate for Payer: Aetna Medicare |
$3,103.77
|
| Rate for Payer: ASR ASR |
$6,021.31
|
| Rate for Payer: ASR Commercial |
$6,021.31
|
| Rate for Payer: BCBS Complete |
$2,483.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,083.35
|
| Rate for Payer: BCN Commercial |
$4,812.71
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$5,835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Healthscope Commercial |
$6,207.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,021.31
|
| Rate for Payer: Mclaren Commercial |
$5,586.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: Nomi Health Commercial |
$5,090.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,439.05
|
| Rate for Payer: Priority Health Narrow Network |
$4,351.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,462.64
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,537.36 |
| Max. Negotiated Rate |
$8,843.40 |
| Rate for Payer: Aetna Commercial |
$7,959.06
|
| Rate for Payer: Aetna Medicare |
$4,421.70
|
| Rate for Payer: ASR ASR |
$8,578.10
|
| Rate for Payer: ASR Commercial |
$8,578.10
|
| Rate for Payer: BCBS Complete |
$3,537.36
|
| Rate for Payer: BCBS Trust/PPO |
$7,241.86
|
| Rate for Payer: BCN Commercial |
$6,856.29
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$8,312.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Healthscope Commercial |
$8,843.40
|
| Rate for Payer: Healthscope Whirlpool |
$8,578.10
|
| Rate for Payer: Mclaren Commercial |
$7,959.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: Nomi Health Commercial |
$7,251.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,748.59
|
| Rate for Payer: Priority Health Narrow Network |
$6,199.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,782.19
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,748.21 |
| Max. Negotiated Rate |
$8,843.40 |
| Rate for Payer: Aetna Commercial |
$7,959.06
|
| Rate for Payer: ASR ASR |
$8,578.10
|
| Rate for Payer: ASR Commercial |
$8,578.10
|
| Rate for Payer: BCBS Trust/PPO |
$7,206.49
|
| Rate for Payer: BCN Commercial |
$6,856.29
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$8,312.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Healthscope Commercial |
$8,843.40
|
| Rate for Payer: Healthscope Whirlpool |
$8,578.10
|
| Rate for Payer: Mclaren Commercial |
$7,959.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: Nomi Health Commercial |
$7,251.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,782.19
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,109.38 |
| Max. Negotiated Rate |
$26,322.12 |
| Rate for Payer: Aetna Commercial |
$23,689.91
|
| Rate for Payer: ASR ASR |
$25,532.46
|
| Rate for Payer: ASR Commercial |
$25,532.46
|
| Rate for Payer: BCBS Trust/PPO |
$21,449.90
|
| Rate for Payer: BCN Commercial |
$20,407.54
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$24,742.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Healthscope Commercial |
$26,322.12
|
| Rate for Payer: Healthscope Whirlpool |
$25,532.46
|
| Rate for Payer: Mclaren Commercial |
$23,689.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: Nomi Health Commercial |
$21,584.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,163.47
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,528.85 |
| Max. Negotiated Rate |
$26,322.12 |
| Rate for Payer: Aetna Commercial |
$23,689.91
|
| Rate for Payer: Aetna Medicare |
$13,161.06
|
| Rate for Payer: ASR ASR |
$25,532.46
|
| Rate for Payer: ASR Commercial |
$25,532.46
|
| Rate for Payer: BCBS Complete |
$10,528.85
|
| Rate for Payer: BCBS Trust/PPO |
$21,555.18
|
| Rate for Payer: BCN Commercial |
$20,407.54
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$24,742.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Healthscope Commercial |
$26,322.12
|
| Rate for Payer: Healthscope Whirlpool |
$25,532.46
|
| Rate for Payer: Mclaren Commercial |
$23,689.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: Nomi Health Commercial |
$21,584.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,063.44
|
| Rate for Payer: Priority Health Narrow Network |
$18,451.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,163.47
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,530.06 |
| Max. Negotiated Rate |
$23,825.16 |
| Rate for Payer: Aetna Commercial |
$21,442.64
|
| Rate for Payer: Aetna Medicare |
$11,912.58
|
| Rate for Payer: ASR ASR |
$23,110.41
|
| Rate for Payer: ASR Commercial |
$23,110.41
|
| Rate for Payer: BCBS Complete |
$9,530.06
|
| Rate for Payer: BCBS Trust/PPO |
$19,510.42
|
| Rate for Payer: BCN Commercial |
$18,471.65
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$22,395.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Healthscope Commercial |
$23,825.16
|
| Rate for Payer: Healthscope Whirlpool |
$23,110.41
|
| Rate for Payer: Mclaren Commercial |
$21,442.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: Nomi Health Commercial |
$19,536.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,875.61
|
| Rate for Payer: Priority Health Narrow Network |
$16,701.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20,966.14
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,486.35 |
| Max. Negotiated Rate |
$23,825.16 |
| Rate for Payer: Aetna Commercial |
$21,442.64
|
| Rate for Payer: ASR ASR |
$23,110.41
|
| Rate for Payer: ASR Commercial |
$23,110.41
|
| Rate for Payer: BCBS Trust/PPO |
$19,415.12
|
| Rate for Payer: BCN Commercial |
$18,471.65
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$22,395.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Healthscope Commercial |
$23,825.16
|
| Rate for Payer: Healthscope Whirlpool |
$23,110.41
|
| Rate for Payer: Mclaren Commercial |
$21,442.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: Nomi Health Commercial |
$19,536.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20,966.14
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,286.45 |
| Max. Negotiated Rate |
$13,216.13 |
| Rate for Payer: Aetna Commercial |
$11,894.52
|
| Rate for Payer: Aetna Medicare |
$6,608.06
|
| Rate for Payer: ASR ASR |
$12,819.65
|
| Rate for Payer: ASR Commercial |
$12,819.65
|
| Rate for Payer: BCBS Complete |
$5,286.45
|
| Rate for Payer: BCBS Trust/PPO |
$10,822.69
|
| Rate for Payer: BCN Commercial |
$10,246.47
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$12,423.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Healthscope Commercial |
$13,216.13
|
| Rate for Payer: Healthscope Whirlpool |
$12,819.65
|
| Rate for Payer: Mclaren Commercial |
$11,894.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: Nomi Health Commercial |
$10,837.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,579.97
|
| Rate for Payer: Priority Health Narrow Network |
$9,264.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,630.19
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,590.48 |
| Max. Negotiated Rate |
$13,216.13 |
| Rate for Payer: Aetna Commercial |
$11,894.52
|
| Rate for Payer: ASR ASR |
$12,819.65
|
| Rate for Payer: ASR Commercial |
$12,819.65
|
| Rate for Payer: BCBS Trust/PPO |
$10,769.82
|
| Rate for Payer: BCN Commercial |
$10,246.47
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$12,423.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Healthscope Commercial |
$13,216.13
|
| Rate for Payer: Healthscope Whirlpool |
$12,819.65
|
| Rate for Payer: Mclaren Commercial |
$11,894.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: Nomi Health Commercial |
$10,837.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,630.19
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,138.36 |
| Max. Negotiated Rate |
$15,597.48 |
| Rate for Payer: Aetna Commercial |
$14,037.73
|
| Rate for Payer: ASR ASR |
$15,129.56
|
| Rate for Payer: ASR Commercial |
$15,129.56
|
| Rate for Payer: BCBS Trust/PPO |
$12,710.39
|
| Rate for Payer: BCN Commercial |
$12,092.73
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$14,661.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Healthscope Commercial |
$15,597.48
|
| Rate for Payer: Healthscope Whirlpool |
$15,129.56
|
| Rate for Payer: Mclaren Commercial |
$14,037.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: Nomi Health Commercial |
$12,789.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,725.78
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,238.99 |
| Max. Negotiated Rate |
$15,597.48 |
| Rate for Payer: Aetna Commercial |
$14,037.73
|
| Rate for Payer: Aetna Medicare |
$7,798.74
|
| Rate for Payer: ASR ASR |
$15,129.56
|
| Rate for Payer: ASR Commercial |
$15,129.56
|
| Rate for Payer: BCBS Complete |
$6,238.99
|
| Rate for Payer: BCBS Trust/PPO |
$12,772.78
|
| Rate for Payer: BCN Commercial |
$12,092.73
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$14,661.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Healthscope Commercial |
$15,597.48
|
| Rate for Payer: Healthscope Whirlpool |
$15,129.56
|
| Rate for Payer: Mclaren Commercial |
$14,037.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: Nomi Health Commercial |
$12,789.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,666.51
|
| Rate for Payer: Priority Health Narrow Network |
$10,933.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,725.78
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$195.90 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: Aetna Medicare |
$93.64
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: ASR Commercial |
$181.65
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: BCBS Trust/PPO |
$153.36
|
| Rate for Payer: BCN Commercial |
$145.19
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Healthscope Whirlpool |
$181.65
|
| Rate for Payer: Mclaren Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.90
|
| Rate for Payer: Priority Health Narrow Network |
$156.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
