|
HC PERIPHERAL INTRODUCER
|
Facility
|
IP
|
$684.29
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.79 |
| Max. Negotiated Rate |
$684.29 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: ASR ASR |
$663.76
|
| Rate for Payer: ASR Commercial |
$663.76
|
| Rate for Payer: BCBS Trust/PPO |
$557.63
|
| Rate for Payer: BCN Commercial |
$530.53
|
| Rate for Payer: Cash Price |
$547.43
|
| Rate for Payer: Cofinity Commercial |
$643.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.43
|
| Rate for Payer: Healthscope Commercial |
$684.29
|
| Rate for Payer: Healthscope Whirlpool |
$663.76
|
| Rate for Payer: Mclaren Commercial |
$615.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.65
|
| Rate for Payer: Nomi Health Commercial |
$561.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.18
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
IP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$622.07 |
| Max. Negotiated Rate |
$957.03 |
| Rate for Payer: Aetna Commercial |
$861.33
|
| Rate for Payer: ASR ASR |
$928.32
|
| Rate for Payer: ASR Commercial |
$928.32
|
| Rate for Payer: BCBS Trust/PPO |
$779.88
|
| Rate for Payer: BCN Commercial |
$741.99
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$899.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Healthscope Commercial |
$957.03
|
| Rate for Payer: Healthscope Whirlpool |
$928.32
|
| Rate for Payer: Mclaren Commercial |
$861.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: Nomi Health Commercial |
$784.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.19
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
OP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$957.03 |
| Rate for Payer: Aetna Commercial |
$861.33
|
| Rate for Payer: Aetna Medicare |
$415.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: ASR ASR |
$928.32
|
| Rate for Payer: ASR Commercial |
$928.32
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCBS Trust/PPO |
$783.71
|
| Rate for Payer: BCN Commercial |
$741.99
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$899.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.29
|
| Rate for Payer: Healthscope Commercial |
$957.03
|
| Rate for Payer: Healthscope Whirlpool |
$928.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$415.29
|
| Rate for Payer: Mclaren Commercial |
$861.33
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: Nomi Health Commercial |
$784.76
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Commercial |
$456.82
|
| Rate for Payer: PHP Medicaid |
$222.60
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$838.55
|
| Rate for Payer: Priority Health Medicare |
$415.29
|
| Rate for Payer: Priority Health Narrow Network |
$670.88
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Exchange |
$643.70
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP DNSP |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$222.60
|
| Rate for Payer: VA VA |
$415.29
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
IP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$459.81 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: ASR ASR |
$686.18
|
| Rate for Payer: ASR Commercial |
$686.18
|
| Rate for Payer: BCBS Trust/PPO |
$576.46
|
| Rate for Payer: BCN Commercial |
$548.45
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$664.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$707.40
|
| Rate for Payer: Healthscope Whirlpool |
$686.18
|
| Rate for Payer: Mclaren Commercial |
$636.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: Nomi Health Commercial |
$580.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.51
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
OP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$282.96 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: Aetna Medicare |
$353.70
|
| Rate for Payer: ASR ASR |
$686.18
|
| Rate for Payer: ASR Commercial |
$686.18
|
| Rate for Payer: BCBS Complete |
$282.96
|
| Rate for Payer: BCBS Trust/PPO |
$579.29
|
| Rate for Payer: BCN Commercial |
$548.45
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$664.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$707.40
|
| Rate for Payer: Healthscope Whirlpool |
$686.18
|
| Rate for Payer: Mclaren Commercial |
$636.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: Nomi Health Commercial |
$580.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.82
|
| Rate for Payer: Priority Health Narrow Network |
$495.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.51
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$369.64 |
| Max. Negotiated Rate |
$568.67 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: ASR ASR |
$551.61
|
| Rate for Payer: ASR Commercial |
$551.61
|
| Rate for Payer: BCBS Trust/PPO |
$463.41
|
| Rate for Payer: BCN Commercial |
$440.89
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$534.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Healthscope Commercial |
$568.67
|
| Rate for Payer: Healthscope Whirlpool |
$551.61
|
| Rate for Payer: Mclaren Commercial |
$511.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.43
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$828.86 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$551.61
|
| Rate for Payer: ASR Commercial |
$551.61
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$465.68
|
| Rate for Payer: BCN Commercial |
$440.89
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$534.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$568.67
|
| Rate for Payer: Healthscope Whirlpool |
$551.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$511.80
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.27
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$398.64
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: Aetna Medicare |
$123.53
|
| Rate for Payer: ASR ASR |
$239.66
|
| Rate for Payer: ASR Commercial |
$239.66
|
| Rate for Payer: BCBS Complete |
$98.83
|
| Rate for Payer: BCBS Trust/PPO |
$202.33
|
| Rate for Payer: BCN Commercial |
$191.55
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$247.07
|
| Rate for Payer: Healthscope Whirlpool |
$239.66
|
| Rate for Payer: Mclaren Commercial |
$222.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.48
|
| Rate for Payer: Priority Health Narrow Network |
$173.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.42
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: ASR ASR |
$239.66
|
| Rate for Payer: ASR Commercial |
$239.66
|
| Rate for Payer: BCBS Trust/PPO |
$201.34
|
| Rate for Payer: BCN Commercial |
$191.55
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$247.07
|
| Rate for Payer: Healthscope Whirlpool |
$239.66
|
| Rate for Payer: Mclaren Commercial |
$222.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.42
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.69 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$303.05
|
| Rate for Payer: Aetna Medicare |
$168.36
|
| Rate for Payer: ASR ASR |
$326.62
|
| Rate for Payer: ASR Commercial |
$326.62
|
| Rate for Payer: BCBS Complete |
$134.69
|
| Rate for Payer: BCBS Trust/PPO |
$275.74
|
| Rate for Payer: BCN Commercial |
$261.06
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$316.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$336.72
|
| Rate for Payer: Healthscope Whirlpool |
$326.62
|
| Rate for Payer: Mclaren Commercial |
$303.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.03
|
| Rate for Payer: Priority Health Narrow Network |
$236.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.31
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.87 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$303.05
|
| Rate for Payer: ASR ASR |
$326.62
|
| Rate for Payer: ASR Commercial |
$326.62
|
| Rate for Payer: BCBS Trust/PPO |
$274.39
|
| Rate for Payer: BCN Commercial |
$261.06
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$316.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$336.72
|
| Rate for Payer: Healthscope Whirlpool |
$326.62
|
| Rate for Payer: Mclaren Commercial |
$303.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.31
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| 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 |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| 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 |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| 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 |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.02
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$32.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,149.64 |
| Max. Negotiated Rate |
$1,768.68 |
| Rate for Payer: Aetna Commercial |
$1,591.81
|
| Rate for Payer: ASR ASR |
$1,715.62
|
| Rate for Payer: ASR Commercial |
$1,715.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.30
|
| Rate for Payer: BCN Commercial |
$1,371.26
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,662.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,768.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.62
|
| Rate for Payer: Mclaren Commercial |
$1,591.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,556.44
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$707.47 |
| Max. Negotiated Rate |
$1,768.68 |
| Rate for Payer: Aetna Commercial |
$1,591.81
|
| Rate for Payer: Aetna Medicare |
$884.34
|
| Rate for Payer: ASR ASR |
$1,715.62
|
| Rate for Payer: ASR Commercial |
$1,715.62
|
| Rate for Payer: BCBS Complete |
$707.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.37
|
| Rate for Payer: BCN Commercial |
$1,371.26
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,662.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,768.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.62
|
| Rate for Payer: Mclaren Commercial |
$1,591.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,549.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,239.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,556.44
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$443.03 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: ASR ASR |
$429.74
|
| Rate for Payer: ASR Commercial |
$429.74
|
| Rate for Payer: BCBS Trust/PPO |
$361.03
|
| Rate for Payer: BCN Commercial |
$343.48
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$416.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Healthscope Commercial |
$443.03
|
| Rate for Payer: Healthscope Whirlpool |
$429.74
|
| Rate for Payer: Mclaren Commercial |
$398.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.87
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$443.03 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: Aetna Medicare |
$237.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: ASR ASR |
$429.74
|
| Rate for Payer: ASR Commercial |
$429.74
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCBS Trust/PPO |
$362.80
|
| Rate for Payer: BCN Commercial |
$343.48
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$416.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$443.03
|
| Rate for Payer: Healthscope Whirlpool |
$429.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.20
|
| Rate for Payer: Mclaren Commercial |
$398.73
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$260.92
|
| Rate for Payer: PHP Medicaid |
$127.14
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.18
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health Narrow Network |
$310.56
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$367.66
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP DNSP |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,203.18 |
| Max. Negotiated Rate |
$15,697.20 |
| Rate for Payer: Aetna Commercial |
$14,127.48
|
| Rate for Payer: ASR ASR |
$15,226.28
|
| Rate for Payer: ASR Commercial |
$15,226.28
|
| Rate for Payer: BCBS Trust/PPO |
$12,791.65
|
| Rate for Payer: BCN Commercial |
$12,170.04
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$14,755.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Healthscope Commercial |
$15,697.20
|
| Rate for Payer: Healthscope Whirlpool |
$15,226.28
|
| Rate for Payer: Mclaren Commercial |
$14,127.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,813.54
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$17,143.36 |
| Rate for Payer: Aetna Commercial |
$14,127.48
|
| Rate for Payer: Aetna Medicare |
$11,060.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: ASR ASR |
$15,226.28
|
| Rate for Payer: ASR Commercial |
$15,226.28
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCBS Trust/PPO |
$12,854.44
|
| Rate for Payer: BCN Commercial |
$12,170.04
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$14,755.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$15,697.20
|
| Rate for Payer: Healthscope Whirlpool |
$15,226.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,060.23
|
| Rate for Payer: Mclaren Commercial |
$14,127.48
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$12,166.25
|
| Rate for Payer: PHP Medicaid |
$5,928.28
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,753.89
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health Narrow Network |
$11,003.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,813.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$17,143.36
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP DNSP |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,795.60 |
| Max. Negotiated Rate |
$16,989.00 |
| Rate for Payer: Aetna Commercial |
$15,290.10
|
| Rate for Payer: Aetna Medicare |
$8,494.50
|
| Rate for Payer: ASR ASR |
$16,479.33
|
| Rate for Payer: ASR Commercial |
$16,479.33
|
| Rate for Payer: BCBS Complete |
$6,795.60
|
| Rate for Payer: BCBS Trust/PPO |
$13,912.29
|
| Rate for Payer: BCN Commercial |
$13,171.57
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$15,969.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$16,989.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,479.33
|
| Rate for Payer: Mclaren Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,885.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,909.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,950.32
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,042.85 |
| Max. Negotiated Rate |
$16,989.00 |
| Rate for Payer: Aetna Commercial |
$15,290.10
|
| Rate for Payer: ASR ASR |
$16,479.33
|
| Rate for Payer: ASR Commercial |
$16,479.33
|
| Rate for Payer: BCBS Trust/PPO |
$13,844.34
|
| Rate for Payer: BCN Commercial |
$13,171.57
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$15,969.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$16,989.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,479.33
|
| Rate for Payer: Mclaren Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,950.32
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$77.25
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: ASR Commercial |
$83.26
|
| Rate for Payer: BCBS Trust/PPO |
$69.94
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Healthscope Whirlpool |
$83.26
|
| Rate for Payer: Mclaren Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.53
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$77.25
|
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: ASR Commercial |
$83.26
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$70.29
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Healthscope Whirlpool |
$83.26
|
| Rate for Payer: Mclaren Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.20
|
| Rate for Payer: Priority Health Narrow Network |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.53
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.66 |
| Max. Negotiated Rate |
$196.64 |
| Rate for Payer: Aetna Commercial |
$176.98
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: ASR ASR |
$190.74
|
| Rate for Payer: ASR Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS Trust/PPO |
$161.03
|
| Rate for Payer: BCN Commercial |
$152.45
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$196.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.74
|
| Rate for Payer: Mclaren Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.30
|
| Rate for Payer: Priority Health Narrow Network |
$137.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.04
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$196.64 |
| Rate for Payer: Aetna Commercial |
$176.98
|
| Rate for Payer: ASR ASR |
$190.74
|
| Rate for Payer: ASR Commercial |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$160.24
|
| Rate for Payer: BCN Commercial |
$152.45
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$196.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.74
|
| Rate for Payer: Mclaren Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.04
|
|
