|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$7,910.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Medicare |
$2,861.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: ASR ASR |
$7,672.70
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,132.62
|
| Rate for Payer: BCN Commercial |
$6,132.62
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$7,435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Healthscope Commercial |
$7,910.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,672.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,861.84
|
| Rate for Payer: Mclaren Commercial |
$7,119.00
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,723.50
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Commercial |
$3,148.02
|
| Rate for Payer: PHP Medicaid |
$1,565.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,537.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,198.10
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,616.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,960.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,537.00 |
| Max. Negotiated Rate |
$7,910.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: ASR ASR |
$7,672.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,132.62
|
| Rate for Payer: BCN Commercial |
$6,132.62
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$7,435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,328.00
|
| Rate for Payer: Healthscope Commercial |
$7,910.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,672.70
|
| Rate for Payer: Mclaren Commercial |
$7,119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,723.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,537.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,960.80
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
OP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.04 |
| Max. Negotiated Rate |
$497.59 |
| Rate for Payer: Aetna Commercial |
$447.83
|
| Rate for Payer: ASR ASR |
$482.66
|
| Rate for Payer: BCBS Complete |
$199.04
|
| Rate for Payer: BCBS Trust/PPO |
$385.78
|
| Rate for Payer: BCN Commercial |
$385.78
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$467.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.07
|
| Rate for Payer: Healthscope Commercial |
$497.59
|
| Rate for Payer: Healthscope Whirlpool |
$482.66
|
| Rate for Payer: Mclaren Commercial |
$447.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.81
|
| Rate for Payer: Priority Health Narrow Network |
$353.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.88
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
IP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.31 |
| Max. Negotiated Rate |
$497.59 |
| Rate for Payer: Aetna Commercial |
$447.83
|
| Rate for Payer: ASR ASR |
$482.66
|
| Rate for Payer: BCBS Trust/PPO |
$385.78
|
| Rate for Payer: BCN Commercial |
$385.78
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$467.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.07
|
| Rate for Payer: Healthscope Commercial |
$497.59
|
| Rate for Payer: Healthscope Whirlpool |
$482.66
|
| Rate for Payer: Mclaren Commercial |
$447.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.88
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
OP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$387.45 |
| Rate for Payer: Aetna Commercial |
$156.67
|
| Rate for Payer: Aetna Medicare |
$217.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: ASR ASR |
$168.86
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$134.96
|
| Rate for Payer: BCN Commercial |
$134.96
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Healthscope Commercial |
$174.08
|
| Rate for Payer: Healthscope Whirlpool |
$168.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.12
|
| Rate for Payer: Mclaren Commercial |
$156.67
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Commercial |
$238.83
|
| Rate for Payer: PHP Medicaid |
$118.76
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.45
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$309.96
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.19
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
IP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.86 |
| Max. Negotiated Rate |
$174.08 |
| Rate for Payer: Aetna Commercial |
$156.67
|
| Rate for Payer: ASR ASR |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$134.96
|
| Rate for Payer: BCN Commercial |
$134.96
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.26
|
| Rate for Payer: Healthscope Commercial |
$174.08
|
| Rate for Payer: Healthscope Whirlpool |
$168.86
|
| Rate for Payer: Mclaren Commercial |
$156.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.19
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| 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 Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| 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 Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| 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 Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$93.84
|
| 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: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.84
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$63.07
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$93.84
|
| 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: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.75
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$83.00
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| 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 Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$24,480.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,136.00 |
| Max. Negotiated Rate |
$24,480.00 |
| Rate for Payer: Aetna Commercial |
$22,032.00
|
| Rate for Payer: ASR ASR |
$23,745.60
|
| Rate for Payer: BCBS Trust/PPO |
$18,979.34
|
| Rate for Payer: BCN Commercial |
$18,979.34
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$23,011.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Healthscope Commercial |
$24,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$23,745.60
|
| Rate for Payer: Mclaren Commercial |
$22,032.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,542.40
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$24,480.00 |
| Rate for Payer: Aetna Commercial |
$22,032.00
|
| Rate for Payer: Aetna Medicare |
$17,319.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,649.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,649.99
|
| Rate for Payer: ASR ASR |
$23,745.60
|
| Rate for Payer: BCBS Complete |
$9,948.60
|
| Rate for Payer: BCBS MAPPO |
$17,319.99
|
| Rate for Payer: BCBS Trust/PPO |
$18,979.34
|
| Rate for Payer: BCN Commercial |
$18,979.34
|
| Rate for Payer: BCN Medicare Advantage |
$17,319.99
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$23,011.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,319.99
|
| Rate for Payer: Healthscope Commercial |
$24,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$23,745.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,319.99
|
| Rate for Payer: Mclaren Commercial |
$22,032.00
|
| Rate for Payer: Mclaren Medicaid |
$9,474.03
|
| Rate for Payer: Mclaren Medicare |
$17,319.99
|
| Rate for Payer: Meridian Medicaid |
$9,948.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,185.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,917.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Medicare |
$16,453.99
|
| Rate for Payer: PACE SWMI |
$17,319.99
|
| Rate for Payer: PHP Commercial |
$19,051.99
|
| Rate for Payer: PHP Medicaid |
$9,474.03
|
| Rate for Payer: PHP Medicare Advantage |
$17,319.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,474.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,429.32
|
| Rate for Payer: Priority Health Medicare |
$17,319.99
|
| Rate for Payer: Priority Health Narrow Network |
$13,143.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17,319.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,542.40
|
| Rate for Payer: UHC Medicare Advantage |
$17,839.59
|
| Rate for Payer: VA VA |
$17,319.99
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
OP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,949.54 |
| Max. Negotiated Rate |
$42,373.86 |
| Rate for Payer: Aetna Commercial |
$38,136.47
|
| Rate for Payer: ASR ASR |
$41,102.64
|
| Rate for Payer: BCBS Complete |
$16,949.54
|
| Rate for Payer: BCBS Trust/PPO |
$32,852.45
|
| Rate for Payer: BCN Commercial |
$32,852.45
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$39,831.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,899.09
|
| Rate for Payer: Healthscope Commercial |
$42,373.86
|
| Rate for Payer: Healthscope Whirlpool |
$41,102.64
|
| Rate for Payer: Mclaren Commercial |
$38,136.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,560.21
|
| Rate for Payer: Priority Health Narrow Network |
$30,085.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37,289.00
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
IP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$29,661.70 |
| Max. Negotiated Rate |
$42,373.86 |
| Rate for Payer: Aetna Commercial |
$38,136.47
|
| Rate for Payer: ASR ASR |
$41,102.64
|
| Rate for Payer: BCBS Trust/PPO |
$32,852.45
|
| Rate for Payer: BCN Commercial |
$32,852.45
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$39,831.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,899.09
|
| Rate for Payer: Healthscope Commercial |
$42,373.86
|
| Rate for Payer: Healthscope Whirlpool |
$41,102.64
|
| Rate for Payer: Mclaren Commercial |
$38,136.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37,289.00
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,814.80 |
| Rate for Payer: Aetna Commercial |
$3,433.32
|
| 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 |
$3,700.36
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,957.61
|
| Rate for Payer: BCN Commercial |
$2,957.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$3,585.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,814.80
|
| Rate for Payer: Healthscope Whirlpool |
$3,700.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,433.32
|
| 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 |
$3,242.58
|
| 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 |
$2,670.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,826.43
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,261.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,357.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,670.36 |
| Max. Negotiated Rate |
$3,814.80 |
| Rate for Payer: Aetna Commercial |
$3,433.32
|
| Rate for Payer: ASR ASR |
$3,700.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,957.61
|
| Rate for Payer: BCN Commercial |
$2,957.61
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$3,585.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.84
|
| Rate for Payer: Healthscope Commercial |
$3,814.80
|
| Rate for Payer: Healthscope Whirlpool |
$3,700.36
|
| Rate for Payer: Mclaren Commercial |
$3,433.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,242.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,670.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,357.02
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
OP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$552.31 |
| Rate for Payer: Aetna Commercial |
$497.08
|
| Rate for Payer: ASR ASR |
$535.74
|
| Rate for Payer: BCBS Complete |
$220.92
|
| Rate for Payer: BCBS Trust/PPO |
$428.21
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$519.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.85
|
| Rate for Payer: Healthscope Commercial |
$552.31
|
| Rate for Payer: Healthscope Whirlpool |
$535.74
|
| Rate for Payer: Mclaren Commercial |
$497.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.60
|
| Rate for Payer: Priority Health Narrow Network |
$392.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.03
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
IP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$386.62 |
| Max. Negotiated Rate |
$552.31 |
| Rate for Payer: Aetna Commercial |
$497.08
|
| Rate for Payer: ASR ASR |
$535.74
|
| Rate for Payer: BCBS Trust/PPO |
$428.21
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$519.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.85
|
| Rate for Payer: Healthscope Commercial |
$552.31
|
| Rate for Payer: Healthscope Whirlpool |
$535.74
|
| Rate for Payer: Mclaren Commercial |
$497.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.03
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
OP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,586.54 |
| Rate for Payer: Aetna Commercial |
$1,427.89
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,538.94
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.04
|
| Rate for Payer: BCN Commercial |
$1,230.04
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,491.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,586.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,427.89
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,443.75
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.44
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,396.16
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,110.58 |
| Max. Negotiated Rate |
$1,586.54 |
| Rate for Payer: Aetna Commercial |
$1,427.89
|
| Rate for Payer: ASR ASR |
$1,538.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.04
|
| Rate for Payer: BCN Commercial |
$1,230.04
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,491.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.23
|
| Rate for Payer: Healthscope Commercial |
$1,586.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.94
|
| Rate for Payer: Mclaren Commercial |
$1,427.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,396.16
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
OP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Aetna Commercial |
$539.50
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$581.47
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$464.75
|
| Rate for Payer: BCN Commercial |
$464.75
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$563.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$599.45
|
| Rate for Payer: Healthscope Whirlpool |
$581.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$539.50
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.50
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$425.61
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$527.52
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
IP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$419.62 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Aetna Commercial |
$539.50
|
| Rate for Payer: ASR ASR |
$581.47
|
| Rate for Payer: BCBS Trust/PPO |
$464.75
|
| Rate for Payer: BCN Commercial |
$464.75
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$563.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.56
|
| Rate for Payer: Healthscope Commercial |
$599.45
|
| Rate for Payer: Healthscope Whirlpool |
$581.47
|
| Rate for Payer: Mclaren Commercial |
$539.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$527.52
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$300.34 |
| Max. Negotiated Rate |
$429.05 |
| Rate for Payer: Aetna Commercial |
$386.14
|
| Rate for Payer: ASR ASR |
$416.18
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$403.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$429.05
|
| Rate for Payer: Healthscope Whirlpool |
$416.18
|
| Rate for Payer: Mclaren Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.56
|
|
