|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$252.01
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$252.01 |
| Rate for Payer: Aetna Commercial |
$226.81
|
| Rate for Payer: Aetna Medicare |
$93.24
|
| Rate for Payer: ASR ASR |
$244.45
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS Trust/PPO |
$207.78
|
| Rate for Payer: BCN Commercial |
$207.78
|
| Rate for Payer: Cash Price |
$201.61
|
| Rate for Payer: Cofinity Commercial |
$236.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.61
|
| Rate for Payer: Healthscope Commercial |
$244.45
|
| Rate for Payer: Healthscope Whirlpool |
$252.01
|
| Rate for Payer: Mclaren Commercial |
$226.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.21
|
| Rate for Payer: Nomi Health Commercial |
$206.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.81
|
| Rate for Payer: Priority Health Narrow Network |
$176.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.77
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$252.01
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.01 |
| Max. Negotiated Rate |
$252.01 |
| Rate for Payer: Aetna Commercial |
$226.81
|
| Rate for Payer: ASR ASR |
$244.45
|
| Rate for Payer: BCBS Trust/PPO |
$206.95
|
| Rate for Payer: BCN Commercial |
$206.95
|
| Rate for Payer: Cash Price |
$201.61
|
| Rate for Payer: Cofinity Commercial |
$236.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.61
|
| Rate for Payer: Healthscope Commercial |
$244.45
|
| Rate for Payer: Healthscope Whirlpool |
$252.01
|
| Rate for Payer: Mclaren Commercial |
$226.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.21
|
| Rate for Payer: Nomi Health Commercial |
$206.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.77
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$343.45
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.59 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Aetna Commercial |
$309.11
|
| Rate for Payer: ASR ASR |
$333.15
|
| Rate for Payer: BCBS Trust/PPO |
$282.04
|
| Rate for Payer: BCN Commercial |
$282.04
|
| Rate for Payer: Cash Price |
$274.76
|
| Rate for Payer: Cofinity Commercial |
$322.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.76
|
| Rate for Payer: Healthscope Commercial |
$333.15
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Mclaren Commercial |
$309.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.93
|
| Rate for Payer: Nomi Health Commercial |
$281.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.24
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$343.45
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$127.08 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Aetna Commercial |
$309.11
|
| Rate for Payer: Aetna Medicare |
$127.08
|
| Rate for Payer: ASR ASR |
$333.15
|
| Rate for Payer: BCBS Complete |
$137.38
|
| Rate for Payer: BCBS Trust/PPO |
$283.17
|
| Rate for Payer: BCN Commercial |
$283.17
|
| Rate for Payer: Cash Price |
$274.76
|
| Rate for Payer: Cofinity Commercial |
$322.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.76
|
| Rate for Payer: Healthscope Commercial |
$333.15
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Mclaren Commercial |
$309.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.93
|
| Rate for Payer: Nomi Health Commercial |
$281.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$300.93
|
| Rate for Payer: Priority Health Narrow Network |
$240.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.24
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.22
|
| Rate for Payer: BCN Commercial |
$39.22
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$39.38
|
| Rate for Payer: BCN Commercial |
$39.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$15.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.08
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.06
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$41.65
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,804.05
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna Commercial |
$1,623.64
|
| Rate for Payer: Aetna Medicare |
$667.50
|
| Rate for Payer: ASR ASR |
$1,749.93
|
| Rate for Payer: BCBS Complete |
$721.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,487.44
|
| Rate for Payer: BCN Commercial |
$1,487.44
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cofinity Commercial |
$1,695.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.24
|
| Rate for Payer: Healthscope Commercial |
$1,749.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,804.05
|
| Rate for Payer: Mclaren Commercial |
$1,623.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,443.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.44
|
| Rate for Payer: Nomi Health Commercial |
$1,479.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$215.91
|
| Rate for Payer: Priority Health Narrow Network |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,587.56
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,804.05
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.04 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna Commercial |
$1,623.64
|
| Rate for Payer: ASR ASR |
$1,749.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.49
|
| Rate for Payer: BCN Commercial |
$1,481.49
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cofinity Commercial |
$1,695.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.24
|
| Rate for Payer: Healthscope Commercial |
$1,749.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,804.05
|
| Rate for Payer: Mclaren Commercial |
$1,623.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.44
|
| Rate for Payer: Nomi Health Commercial |
$1,479.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,587.56
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$451.89
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$451.89 |
| Rate for Payer: Aetna Commercial |
$406.70
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$438.33
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$372.58
|
| Rate for Payer: BCN Commercial |
$372.58
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cofinity Commercial |
$424.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$438.33
|
| Rate for Payer: Healthscope Whirlpool |
$451.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$406.70
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.11
|
| Rate for Payer: Nomi Health Commercial |
$370.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.92
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.11
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$233.69
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$451.89
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.92 |
| Max. Negotiated Rate |
$451.89 |
| Rate for Payer: Aetna Commercial |
$406.70
|
| Rate for Payer: ASR ASR |
$438.33
|
| Rate for Payer: BCBS Trust/PPO |
$371.09
|
| Rate for Payer: BCN Commercial |
$371.09
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cofinity Commercial |
$424.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.51
|
| Rate for Payer: Healthscope Commercial |
$438.33
|
| Rate for Payer: Healthscope Whirlpool |
$451.89
|
| Rate for Payer: Mclaren Commercial |
$406.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.11
|
| Rate for Payer: Nomi Health Commercial |
$370.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.66
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
OP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,028.74 |
| Max. Negotiated Rate |
$29,485.58 |
| Rate for Payer: Aetna Commercial |
$26,537.02
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$28,601.01
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$24,310.86
|
| Rate for Payer: BCN Commercial |
$24,310.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Commercial |
$27,716.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$28,601.01
|
| Rate for Payer: Healthscope Whirlpool |
$29,485.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$26,537.02
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,062.74
|
| Rate for Payer: Nomi Health Commercial |
$24,178.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,285.93
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$5,028.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,947.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
IP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,114.19 |
| Max. Negotiated Rate |
$29,485.58 |
| Rate for Payer: Aetna Commercial |
$26,537.02
|
| Rate for Payer: ASR ASR |
$28,601.01
|
| Rate for Payer: BCBS Trust/PPO |
$24,213.56
|
| Rate for Payer: BCN Commercial |
$24,213.56
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Commercial |
$27,716.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Healthscope Commercial |
$28,601.01
|
| Rate for Payer: Healthscope Whirlpool |
$29,485.58
|
| Rate for Payer: Mclaren Commercial |
$26,537.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,062.74
|
| Rate for Payer: Nomi Health Commercial |
$24,178.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,947.31
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
OP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,454.83 |
| Max. Negotiated Rate |
$14,742.79 |
| Rate for Payer: Aetna Commercial |
$13,268.51
|
| Rate for Payer: Aetna Medicare |
$5,454.83
|
| Rate for Payer: ASR ASR |
$14,300.51
|
| Rate for Payer: BCBS Complete |
$5,897.12
|
| Rate for Payer: BCBS Trust/PPO |
$12,155.43
|
| Rate for Payer: BCN Commercial |
$12,155.43
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Commercial |
$13,858.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Healthscope Commercial |
$14,300.51
|
| Rate for Payer: Healthscope Whirlpool |
$14,742.79
|
| Rate for Payer: Mclaren Commercial |
$13,268.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,794.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Nomi Health Commercial |
$12,089.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,917.63
|
| Rate for Payer: Priority Health Narrow Network |
$10,334.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,973.66
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
IP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,057.09 |
| Max. Negotiated Rate |
$14,742.79 |
| Rate for Payer: Aetna Commercial |
$13,268.51
|
| Rate for Payer: ASR ASR |
$14,300.51
|
| Rate for Payer: BCBS Trust/PPO |
$12,106.78
|
| Rate for Payer: BCN Commercial |
$12,106.78
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Commercial |
$13,858.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Healthscope Commercial |
$14,300.51
|
| Rate for Payer: Healthscope Whirlpool |
$14,742.79
|
| Rate for Payer: Mclaren Commercial |
$13,268.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Nomi Health Commercial |
$12,089.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,973.66
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,600.00 |
| Max. Negotiated Rate |
$16,800.00 |
| Rate for Payer: Aetna Commercial |
$15,120.00
|
| Rate for Payer: ASR ASR |
$16,296.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,796.16
|
| Rate for Payer: BCN Commercial |
$13,796.16
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Commercial |
$15,792.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Healthscope Commercial |
$16,296.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,800.00
|
| Rate for Payer: Mclaren Commercial |
$15,120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Nomi Health Commercial |
$13,776.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,784.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,216.00 |
| Max. Negotiated Rate |
$16,800.00 |
| Rate for Payer: Aetna Commercial |
$15,120.00
|
| Rate for Payer: Aetna Medicare |
$6,216.00
|
| Rate for Payer: ASR ASR |
$16,296.00
|
| Rate for Payer: BCBS Complete |
$6,720.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,851.60
|
| Rate for Payer: BCN Commercial |
$13,851.60
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Commercial |
$15,792.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Healthscope Commercial |
$16,296.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,800.00
|
| Rate for Payer: Mclaren Commercial |
$15,120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,440.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Nomi Health Commercial |
$13,776.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,720.16
|
| Rate for Payer: Priority Health Narrow Network |
$11,776.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,784.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
OP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,637.50 |
| Max. Negotiated Rate |
$28,750.00 |
| Rate for Payer: Aetna Commercial |
$25,875.00
|
| Rate for Payer: Aetna Medicare |
$10,637.50
|
| Rate for Payer: ASR ASR |
$27,887.50
|
| Rate for Payer: BCBS Complete |
$11,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,704.38
|
| Rate for Payer: BCN Commercial |
$23,704.38
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Commercial |
$27,025.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Healthscope Commercial |
$27,887.50
|
| Rate for Payer: Healthscope Whirlpool |
$28,750.00
|
| Rate for Payer: Mclaren Commercial |
$25,875.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Nomi Health Commercial |
$23,575.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,190.75
|
| Rate for Payer: Priority Health Narrow Network |
$20,153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,300.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
IP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21,562.50 |
| Max. Negotiated Rate |
$28,750.00 |
| Rate for Payer: Aetna Commercial |
$25,875.00
|
| Rate for Payer: ASR ASR |
$27,887.50
|
| Rate for Payer: BCBS Trust/PPO |
$23,609.50
|
| Rate for Payer: BCN Commercial |
$23,609.50
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Commercial |
$27,025.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Healthscope Commercial |
$27,887.50
|
| Rate for Payer: Healthscope Whirlpool |
$28,750.00
|
| Rate for Payer: Mclaren Commercial |
$25,875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Nomi Health Commercial |
$23,575.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,300.00
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$36,975.00 |
| Max. Negotiated Rate |
$49,300.00 |
| Rate for Payer: Aetna Commercial |
$44,370.00
|
| Rate for Payer: ASR ASR |
$47,821.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,485.16
|
| Rate for Payer: BCN Commercial |
$40,485.16
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$46,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$47,821.00
|
| Rate for Payer: Healthscope Whirlpool |
$49,300.00
|
| Rate for Payer: Mclaren Commercial |
$44,370.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43,384.00
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,170.33 |
| Max. Negotiated Rate |
$49,300.00 |
| Rate for Payer: Aetna Commercial |
$44,370.00
|
| Rate for Payer: Aetna Medicare |
$18,265.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: ASR ASR |
$47,821.00
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$40,647.85
|
| Rate for Payer: BCN Commercial |
$40,647.85
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$46,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$47,821.00
|
| Rate for Payer: Healthscope Whirlpool |
$49,300.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,265.72
|
| Rate for Payer: Mclaren Commercial |
$44,370.00
|
| Rate for Payer: Mclaren Medicaid |
$18,265.72
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$10,031.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$20,092.29
|
| Rate for Payer: PHP Medicaid |
$9,790.43
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,712.91
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health Narrow Network |
$6,170.33
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43,384.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Exchange |
$28,311.87
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP DNSP |
$18,265.72
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,900.00 |
| Max. Negotiated Rate |
$25,200.00 |
| Rate for Payer: Aetna Commercial |
$22,680.00
|
| Rate for Payer: ASR ASR |
$24,444.00
|
| Rate for Payer: BCBS Trust/PPO |
$20,694.24
|
| Rate for Payer: BCN Commercial |
$20,694.24
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Commercial |
$23,688.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Healthscope Commercial |
$24,444.00
|
| Rate for Payer: Healthscope Whirlpool |
$25,200.00
|
| Rate for Payer: Mclaren Commercial |
$22,680.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Nomi Health Commercial |
$20,664.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,176.00
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$25,200.00 |
| Rate for Payer: Aetna Commercial |
$22,680.00
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$24,444.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$20,777.40
|
| Rate for Payer: BCN Commercial |
$20,777.40
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Commercial |
$23,688.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$24,444.00
|
| Rate for Payer: Healthscope Whirlpool |
$25,200.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$22,680.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Nomi Health Commercial |
$20,664.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,712.91
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$6,170.33
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,176.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
IP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,950.00 |
| Max. Negotiated Rate |
$42,600.00 |
| Rate for Payer: Aetna Commercial |
$38,340.00
|
| Rate for Payer: ASR ASR |
$41,322.00
|
| Rate for Payer: BCBS Trust/PPO |
$34,983.12
|
| Rate for Payer: BCN Commercial |
$34,983.12
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Commercial |
$40,044.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Healthscope Commercial |
$41,322.00
|
| Rate for Payer: Healthscope Whirlpool |
$42,600.00
|
| Rate for Payer: Mclaren Commercial |
$38,340.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Nomi Health Commercial |
$34,932.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37,488.00
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
OP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$42,600.00 |
| Rate for Payer: Aetna Commercial |
$38,340.00
|
| Rate for Payer: Aetna Medicare |
$18,265.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: ASR ASR |
$41,322.00
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$35,123.70
|
| Rate for Payer: BCN Commercial |
$35,123.70
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Commercial |
$40,044.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$41,322.00
|
| Rate for Payer: Healthscope Whirlpool |
$42,600.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,265.72
|
| Rate for Payer: Mclaren Commercial |
$38,340.00
|
| Rate for Payer: Mclaren Medicaid |
$18,265.72
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$10,031.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Nomi Health Commercial |
$34,932.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$20,092.29
|
| Rate for Payer: PHP Medicaid |
$9,790.43
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,665.12
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health Narrow Network |
$15,732.10
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37,488.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Exchange |
$28,311.87
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP DNSP |
$18,265.72
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$37,500.00 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,060.00
|
| Rate for Payer: BCN Commercial |
$41,060.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
|
