|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
IP
|
$4,869.66
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,408.76 |
| Max. Negotiated Rate |
$4,869.66 |
| Rate for Payer: Aetna Commercial |
$4,382.69
|
| Rate for Payer: ASR ASR |
$4,723.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,775.45
|
| Rate for Payer: BCN Commercial |
$3,775.45
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cofinity Commercial |
$4,577.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,895.73
|
| Rate for Payer: Healthscope Commercial |
$4,869.66
|
| Rate for Payer: Healthscope Whirlpool |
$4,723.57
|
| Rate for Payer: Mclaren Commercial |
$4,382.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,139.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,408.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,285.30
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
OP
|
$4,869.66
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$4,869.66 |
| Rate for Payer: Aetna Commercial |
$4,382.69
|
| Rate for Payer: ASR ASR |
$4,723.57
|
| Rate for Payer: BCBS Complete |
$1,947.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,775.45
|
| Rate for Payer: BCN Commercial |
$3,775.45
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cofinity Commercial |
$4,577.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,895.73
|
| Rate for Payer: Healthscope Commercial |
$4,869.66
|
| Rate for Payer: Healthscope Whirlpool |
$4,723.57
|
| Rate for Payer: Mclaren Commercial |
$4,382.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,139.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,408.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,285.30
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
IP
|
$5,633.63
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,943.54 |
| Max. Negotiated Rate |
$5,633.63 |
| Rate for Payer: Aetna Commercial |
$5,070.27
|
| Rate for Payer: ASR ASR |
$5,464.62
|
| Rate for Payer: BCBS Trust/PPO |
$4,367.75
|
| Rate for Payer: BCN Commercial |
$4,367.75
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cofinity Commercial |
$5,295.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,506.90
|
| Rate for Payer: Healthscope Commercial |
$5,633.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,464.62
|
| Rate for Payer: Mclaren Commercial |
$5,070.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,788.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,957.59
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
OP
|
$5,633.63
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5,633.63 |
| Rate for Payer: Aetna Commercial |
$5,070.27
|
| Rate for Payer: ASR ASR |
$5,464.62
|
| Rate for Payer: BCBS Complete |
$2,253.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,367.75
|
| Rate for Payer: BCN Commercial |
$4,367.75
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cofinity Commercial |
$5,295.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,506.90
|
| Rate for Payer: Healthscope Commercial |
$5,633.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,464.62
|
| Rate for Payer: Mclaren Commercial |
$5,070.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,788.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,957.59
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$9,359.88
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$9,359.88 |
| Rate for Payer: Aetna Commercial |
$8,423.89
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$9,079.08
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,256.71
|
| Rate for Payer: BCN Commercial |
$7,256.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,798.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$9,359.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,079.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$8,423.89
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,375.21
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,900.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,236.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$9,359.88
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,551.92 |
| Max. Negotiated Rate |
$9,359.88 |
| Rate for Payer: Aetna Commercial |
$8,423.89
|
| Rate for Payer: ASR ASR |
$9,079.08
|
| Rate for Payer: BCBS Trust/PPO |
$7,256.71
|
| Rate for Payer: BCN Commercial |
$7,256.71
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,798.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Healthscope Commercial |
$9,359.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,079.08
|
| Rate for Payer: Mclaren Commercial |
$8,423.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,236.69
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$10,751.21
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,525.85 |
| Max. Negotiated Rate |
$10,751.21 |
| Rate for Payer: Aetna Commercial |
$9,676.09
|
| Rate for Payer: ASR ASR |
$10,428.67
|
| Rate for Payer: BCBS Trust/PPO |
$8,335.41
|
| Rate for Payer: BCN Commercial |
$8,335.41
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cofinity Commercial |
$10,106.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.97
|
| Rate for Payer: Healthscope Commercial |
$10,751.21
|
| Rate for Payer: Healthscope Whirlpool |
$10,428.67
|
| Rate for Payer: Mclaren Commercial |
$9,676.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,138.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,525.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,461.06
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$10,751.21
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,900.17 |
| Max. Negotiated Rate |
$10,751.21 |
| Rate for Payer: Aetna Commercial |
$9,676.09
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$10,428.67
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$8,335.41
|
| Rate for Payer: BCN Commercial |
$8,335.41
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cofinity Commercial |
$10,106.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$10,751.21
|
| Rate for Payer: Healthscope Whirlpool |
$10,428.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$9,676.09
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,138.53
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,375.21
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,900.17
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,461.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
OP
|
$12,648.49
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,671.93 |
| Max. Negotiated Rate |
$12,648.49 |
| Rate for Payer: Aetna Commercial |
$11,383.64
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$12,269.04
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,806.37
|
| Rate for Payer: BCN Commercial |
$9,806.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$11,889.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,118.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$12,648.49
|
| Rate for Payer: Healthscope Whirlpool |
$12,269.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$11,383.64
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,884.53
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$3,107.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,130.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
IP
|
$12,648.49
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,853.94 |
| Max. Negotiated Rate |
$12,648.49 |
| Rate for Payer: Aetna Commercial |
$11,383.64
|
| Rate for Payer: ASR ASR |
$12,269.04
|
| Rate for Payer: BCBS Trust/PPO |
$9,806.37
|
| Rate for Payer: BCN Commercial |
$9,806.37
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$11,889.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,118.79
|
| Rate for Payer: Healthscope Commercial |
$12,648.49
|
| Rate for Payer: Healthscope Whirlpool |
$12,269.04
|
| Rate for Payer: Mclaren Commercial |
$11,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,130.67
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$12,648.49
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,671.93 |
| Max. Negotiated Rate |
$12,648.49 |
| Rate for Payer: Aetna Commercial |
$11,383.64
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$12,269.04
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,806.37
|
| Rate for Payer: BCN Commercial |
$9,806.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$11,889.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,118.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$12,648.49
|
| Rate for Payer: Healthscope Whirlpool |
$12,269.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$11,383.64
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,884.53
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$3,107.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,130.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$12,648.49
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,853.94 |
| Max. Negotiated Rate |
$12,648.49 |
| Rate for Payer: Aetna Commercial |
$11,383.64
|
| Rate for Payer: ASR ASR |
$12,269.04
|
| Rate for Payer: BCBS Trust/PPO |
$9,806.37
|
| Rate for Payer: BCN Commercial |
$9,806.37
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$11,889.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,118.79
|
| Rate for Payer: Healthscope Commercial |
$12,648.49
|
| Rate for Payer: Healthscope Whirlpool |
$12,269.04
|
| Rate for Payer: Mclaren Commercial |
$11,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,130.67
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,180.42 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.40
|
| Rate for Payer: BCN Commercial |
$1,307.40
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,686.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,635.73
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
OP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.53 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: BCBS Complete |
$674.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.40
|
| Rate for Payer: BCN Commercial |
$1,307.40
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,686.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,635.73
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,534.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.53
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.96
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Medicaid |
$14.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Medicaid |
$13.96
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.30
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.51
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: ASR ASR |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.40
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.49
|
| Rate for Payer: Mclaren Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.45
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.51
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: ASR ASR |
$0.49
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.40
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.49
|
| Rate for Payer: Mclaren Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.46
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.45
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Trust/PPO |
$36.44
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.44
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.77
|
| Rate for Payer: Priority Health Narrow Network |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.31
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.31
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: PHP Medicaid |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.83
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: Priority Health Narrow Network |
$80.23
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
| Rate for Payer: UHC Medicare Advantage |
$12.68
|
| Rate for Payer: VA VA |
$12.31
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS Trust/PPO |
$290.74
|
| Rate for Payer: BCN Commercial |
$290.74
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$375.00
|
| Rate for Payer: Healthscope Whirlpool |
$363.75
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$341.25
|
| Rate for Payer: Priority Health Narrow Network |
$266.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
|
