|
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
|
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 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 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 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 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
|
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 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 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 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 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 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 MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: ASR Commercial |
$181.65
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$145.19
|
| 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: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
|
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 |
$187.27 |
| 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: 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 |
$164.09
|
| Rate for Payer: Priority Health Narrow Network |
$131.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.76 |
| Max. Negotiated Rate |
$526.91 |
| Rate for Payer: Aetna Commercial |
$474.22
|
| Rate for Payer: Aetna Medicare |
$263.45
|
| Rate for Payer: ASR ASR |
$511.10
|
| Rate for Payer: ASR Commercial |
$511.10
|
| Rate for Payer: BCBS Complete |
$210.76
|
| Rate for Payer: BCBS Trust/PPO |
$431.49
|
| Rate for Payer: BCN Commercial |
$408.51
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$495.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Healthscope Commercial |
$526.91
|
| Rate for Payer: Healthscope Whirlpool |
$511.10
|
| Rate for Payer: Mclaren Commercial |
$474.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: Nomi Health Commercial |
$432.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$461.68
|
| Rate for Payer: Priority Health Narrow Network |
$369.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.68
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$342.49 |
| Max. Negotiated Rate |
$526.91 |
| Rate for Payer: Aetna Commercial |
$474.22
|
| Rate for Payer: ASR ASR |
$511.10
|
| Rate for Payer: ASR Commercial |
$511.10
|
| Rate for Payer: BCBS Trust/PPO |
$429.38
|
| Rate for Payer: BCN Commercial |
$408.51
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$495.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Healthscope Commercial |
$526.91
|
| Rate for Payer: Healthscope Whirlpool |
$511.10
|
| Rate for Payer: Mclaren Commercial |
$474.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: Nomi Health Commercial |
$432.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.68
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$263.16 |
| Rate for Payer: Aetna Commercial |
$236.84
|
| Rate for Payer: Aetna Medicare |
$131.58
|
| Rate for Payer: ASR ASR |
$255.27
|
| Rate for Payer: ASR Commercial |
$255.27
|
| Rate for Payer: BCBS Complete |
$105.26
|
| Rate for Payer: BCBS Trust/PPO |
$215.50
|
| Rate for Payer: BCN Commercial |
$204.03
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$247.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Healthscope Commercial |
$263.16
|
| Rate for Payer: Healthscope Whirlpool |
$255.27
|
| Rate for Payer: Mclaren Commercial |
$236.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.58
|
| Rate for Payer: Priority Health Narrow Network |
$184.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.58
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$263.16 |
| Rate for Payer: Aetna Commercial |
$236.84
|
| Rate for Payer: ASR ASR |
$255.27
|
| Rate for Payer: ASR Commercial |
$255.27
|
| Rate for Payer: BCBS Trust/PPO |
$214.45
|
| Rate for Payer: BCN Commercial |
$204.03
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$247.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Healthscope Commercial |
$263.16
|
| Rate for Payer: Healthscope Whirlpool |
$255.27
|
| Rate for Payer: Mclaren Commercial |
$236.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.58
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$20.23 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.05
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$6.99
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: PHP Medicaid |
$6.99
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Exchange |
$20.23
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHCCP DNSP |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: VA VA |
$13.05
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.15 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.53
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
|
HC MENENCEPH CMPT 11
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200258
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.15 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.53
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
|
HC MENENCEPH CMPT 11
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200258
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 12
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200328
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.15 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.53
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
