|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,262.87
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,505.15 |
| Max. Negotiated Rate |
$6,262.87 |
| Rate for Payer: Aetna Commercial |
$5,636.58
|
| Rate for Payer: Aetna Medicare |
$3,131.44
|
| Rate for Payer: ASR ASR |
$6,074.98
|
| Rate for Payer: ASR Commercial |
$6,074.98
|
| Rate for Payer: BCBS Complete |
$2,505.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,128.66
|
| Rate for Payer: BCN Commercial |
$4,855.60
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cofinity Commercial |
$5,887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.30
|
| Rate for Payer: Healthscope Commercial |
$6,262.87
|
| Rate for Payer: Healthscope Whirlpool |
$6,074.98
|
| Rate for Payer: Mclaren Commercial |
$5,636.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.44
|
| Rate for Payer: Nomi Health Commercial |
$5,135.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,487.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,390.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,511.33
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,444.83
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,589.14 |
| Max. Negotiated Rate |
$2,444.83 |
| Rate for Payer: Aetna Commercial |
$2,200.35
|
| Rate for Payer: ASR ASR |
$2,371.49
|
| Rate for Payer: ASR Commercial |
$2,371.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.29
|
| Rate for Payer: BCN Commercial |
$1,895.48
|
| Rate for Payer: Cash Price |
$1,955.86
|
| Rate for Payer: Cofinity Commercial |
$2,298.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.86
|
| Rate for Payer: Healthscope Commercial |
$2,444.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,371.49
|
| Rate for Payer: Mclaren Commercial |
$2,200.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.11
|
| Rate for Payer: Nomi Health Commercial |
$2,004.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,589.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,151.45
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,444.83
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$977.93 |
| Max. Negotiated Rate |
$2,444.83 |
| Rate for Payer: Aetna Commercial |
$2,200.35
|
| Rate for Payer: Aetna Medicare |
$1,222.42
|
| Rate for Payer: ASR ASR |
$2,371.49
|
| Rate for Payer: ASR Commercial |
$2,371.49
|
| Rate for Payer: BCBS Complete |
$977.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,002.07
|
| Rate for Payer: BCN Commercial |
$1,895.48
|
| Rate for Payer: Cash Price |
$1,955.86
|
| Rate for Payer: Cofinity Commercial |
$2,298.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.86
|
| Rate for Payer: Healthscope Commercial |
$2,444.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,371.49
|
| Rate for Payer: Mclaren Commercial |
$2,200.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.11
|
| Rate for Payer: Nomi Health Commercial |
$2,004.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,589.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,142.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,713.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,151.45
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,849.48 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.94
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,152.34
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,372.91
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,698.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,849.48 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.94
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$8,209.42 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: Aetna Medicare |
$5,296.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,152.34
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,296.40
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$5,826.04
|
| Rate for Payer: PHP Medicaid |
$2,838.87
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,372.91
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,698.49
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,209.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP DNSP |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.44 |
| Max. Negotiated Rate |
$414.53 |
| Rate for Payer: Aetna Commercial |
$373.08
|
| Rate for Payer: ASR ASR |
$402.09
|
| Rate for Payer: ASR Commercial |
$402.09
|
| Rate for Payer: BCBS Trust/PPO |
$337.80
|
| Rate for Payer: BCN Commercial |
$321.39
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$414.53
|
| Rate for Payer: Healthscope Whirlpool |
$402.09
|
| Rate for Payer: Mclaren Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.79
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$414.53 |
| Rate for Payer: Aetna Commercial |
$373.08
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: ASR ASR |
$402.09
|
| Rate for Payer: ASR Commercial |
$402.09
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: BCBS Trust/PPO |
$339.46
|
| Rate for Payer: BCN Commercial |
$321.39
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$414.53
|
| Rate for Payer: Healthscope Whirlpool |
$402.09
|
| Rate for Payer: Mclaren Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.21
|
| Rate for Payer: Priority Health Narrow Network |
$290.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.79
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$1,024.11 |
| Rate for Payer: Aetna Commercial |
$921.70
|
| Rate for Payer: Aetna Medicare |
$512.06
|
| Rate for Payer: ASR ASR |
$993.39
|
| Rate for Payer: ASR Commercial |
$993.39
|
| Rate for Payer: BCBS Complete |
$409.64
|
| Rate for Payer: BCBS Trust/PPO |
$838.64
|
| Rate for Payer: BCN Commercial |
$793.99
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$962.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$1,024.11
|
| Rate for Payer: Healthscope Whirlpool |
$993.39
|
| Rate for Payer: Mclaren Commercial |
$921.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: Nomi Health Commercial |
$839.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.33
|
| Rate for Payer: Priority Health Narrow Network |
$717.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.22
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.67 |
| Max. Negotiated Rate |
$1,024.11 |
| Rate for Payer: Aetna Commercial |
$921.70
|
| Rate for Payer: ASR ASR |
$993.39
|
| Rate for Payer: ASR Commercial |
$993.39
|
| Rate for Payer: BCBS Trust/PPO |
$834.55
|
| Rate for Payer: BCN Commercial |
$793.99
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$962.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$1,024.11
|
| Rate for Payer: Healthscope Whirlpool |
$993.39
|
| Rate for Payer: Mclaren Commercial |
$921.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: Nomi Health Commercial |
$839.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.22
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$511.05 |
| Max. Negotiated Rate |
$1,277.63 |
| Rate for Payer: Aetna Commercial |
$1,149.87
|
| Rate for Payer: Aetna Medicare |
$638.82
|
| Rate for Payer: ASR ASR |
$1,239.30
|
| Rate for Payer: ASR Commercial |
$1,239.30
|
| Rate for Payer: BCBS Complete |
$511.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.25
|
| Rate for Payer: BCN Commercial |
$990.55
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$1,200.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,277.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,239.30
|
| Rate for Payer: Mclaren Commercial |
$1,149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: Nomi Health Commercial |
$1,047.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,119.46
|
| Rate for Payer: Priority Health Narrow Network |
$895.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,124.31
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$830.46 |
| Max. Negotiated Rate |
$1,277.63 |
| Rate for Payer: Aetna Commercial |
$1,149.87
|
| Rate for Payer: ASR ASR |
$1,239.30
|
| Rate for Payer: ASR Commercial |
$1,239.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.14
|
| Rate for Payer: BCN Commercial |
$990.55
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$1,200.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,277.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,239.30
|
| Rate for Payer: Mclaren Commercial |
$1,149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: Nomi Health Commercial |
$1,047.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,124.31
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.80 |
| Max. Negotiated Rate |
$6,757.01 |
| Rate for Payer: Aetna Commercial |
$6,081.31
|
| Rate for Payer: Aetna Medicare |
$3,378.50
|
| Rate for Payer: ASR ASR |
$6,554.30
|
| Rate for Payer: ASR Commercial |
$6,554.30
|
| Rate for Payer: BCBS Complete |
$2,702.80
|
| Rate for Payer: BCBS Trust/PPO |
$5,533.32
|
| Rate for Payer: BCN Commercial |
$5,238.71
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$6,351.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,757.01
|
| Rate for Payer: Healthscope Whirlpool |
$6,554.30
|
| Rate for Payer: Mclaren Commercial |
$6,081.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: Nomi Health Commercial |
$5,540.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,920.49
|
| Rate for Payer: Priority Health Narrow Network |
$4,736.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,946.17
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,392.06 |
| Max. Negotiated Rate |
$6,757.01 |
| Rate for Payer: Aetna Commercial |
$6,081.31
|
| Rate for Payer: ASR ASR |
$6,554.30
|
| Rate for Payer: ASR Commercial |
$6,554.30
|
| Rate for Payer: BCBS Trust/PPO |
$5,506.29
|
| Rate for Payer: BCN Commercial |
$5,238.71
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$6,351.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,757.01
|
| Rate for Payer: Healthscope Whirlpool |
$6,554.30
|
| Rate for Payer: Mclaren Commercial |
$6,081.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: Nomi Health Commercial |
$5,540.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,946.17
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,567.30 |
| Max. Negotiated Rate |
$56,418.24 |
| Rate for Payer: Aetna Commercial |
$50,776.42
|
| Rate for Payer: Aetna Medicare |
$28,209.12
|
| Rate for Payer: ASR ASR |
$54,725.69
|
| Rate for Payer: ASR Commercial |
$54,725.69
|
| Rate for Payer: BCBS Complete |
$22,567.30
|
| Rate for Payer: BCBS Trust/PPO |
$46,200.90
|
| Rate for Payer: BCN Commercial |
$43,741.06
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$53,033.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$56,418.24
|
| Rate for Payer: Healthscope Whirlpool |
$54,725.69
|
| Rate for Payer: Mclaren Commercial |
$50,776.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: Nomi Health Commercial |
$46,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,433.66
|
| Rate for Payer: Priority Health Narrow Network |
$39,549.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49,648.05
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,671.86 |
| Max. Negotiated Rate |
$56,418.24 |
| Rate for Payer: Aetna Commercial |
$50,776.42
|
| Rate for Payer: ASR ASR |
$54,725.69
|
| Rate for Payer: ASR Commercial |
$54,725.69
|
| Rate for Payer: BCBS Trust/PPO |
$45,975.22
|
| Rate for Payer: BCN Commercial |
$43,741.06
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$53,033.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$56,418.24
|
| Rate for Payer: Healthscope Whirlpool |
$54,725.69
|
| Rate for Payer: Mclaren Commercial |
$50,776.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: Nomi Health Commercial |
$46,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49,648.05
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,865.00 |
| Max. Negotiated Rate |
$14,662.50 |
| Rate for Payer: Aetna Commercial |
$13,196.25
|
| Rate for Payer: Aetna Medicare |
$7,331.25
|
| Rate for Payer: ASR ASR |
$14,222.62
|
| Rate for Payer: ASR Commercial |
$14,222.62
|
| Rate for Payer: BCBS Complete |
$5,865.00
|
| Rate for Payer: BCBS Trust/PPO |
$12,007.12
|
| Rate for Payer: BCN Commercial |
$11,367.84
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$13,782.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$14,662.50
|
| Rate for Payer: Healthscope Whirlpool |
$14,222.62
|
| Rate for Payer: Mclaren Commercial |
$13,196.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: Nomi Health Commercial |
$12,023.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,847.28
|
| Rate for Payer: Priority Health Narrow Network |
$10,278.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,903.00
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,530.62 |
| Max. Negotiated Rate |
$14,662.50 |
| Rate for Payer: Aetna Commercial |
$13,196.25
|
| Rate for Payer: ASR ASR |
$14,222.62
|
| Rate for Payer: ASR Commercial |
$14,222.62
|
| Rate for Payer: BCBS Trust/PPO |
$11,948.47
|
| Rate for Payer: BCN Commercial |
$11,367.84
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$13,782.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$14,662.50
|
| Rate for Payer: Healthscope Whirlpool |
$14,222.62
|
| Rate for Payer: Mclaren Commercial |
$13,196.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: Nomi Health Commercial |
$12,023.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,903.00
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$246.51 |
| Rate for Payer: Aetna Commercial |
$221.86
|
| Rate for Payer: ASR ASR |
$239.11
|
| Rate for Payer: ASR Commercial |
$239.11
|
| Rate for Payer: BCBS Trust/PPO |
$200.88
|
| Rate for Payer: BCN Commercial |
$191.12
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$231.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Healthscope Commercial |
$246.51
|
| Rate for Payer: Healthscope Whirlpool |
$239.11
|
| Rate for Payer: Mclaren Commercial |
$221.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: Nomi Health Commercial |
$202.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.93
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$246.51 |
| Rate for Payer: Aetna Commercial |
$221.86
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$239.11
|
| Rate for Payer: ASR Commercial |
$239.11
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$201.87
|
| Rate for Payer: BCN Commercial |
$191.12
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$231.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$246.51
|
| Rate for Payer: Healthscope Whirlpool |
$239.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren Commercial |
$221.86
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: Nomi Health Commercial |
$202.14
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.26
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$65.01
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$498.94 |
| Rate for Payer: Aetna Commercial |
$449.05
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$483.97
|
| Rate for Payer: ASR Commercial |
$483.97
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$408.58
|
| Rate for Payer: BCN Commercial |
$386.83
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$469.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$498.94
|
| Rate for Payer: Healthscope Whirlpool |
$483.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren Commercial |
$449.05
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: Nomi Health Commercial |
$409.13
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.26
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$65.01
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$324.31 |
| Max. Negotiated Rate |
$498.94 |
| Rate for Payer: Aetna Commercial |
$449.05
|
| Rate for Payer: ASR ASR |
$483.97
|
| Rate for Payer: ASR Commercial |
$483.97
|
| Rate for Payer: BCBS Trust/PPO |
$406.59
|
| Rate for Payer: BCN Commercial |
$386.83
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$469.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Healthscope Commercial |
$498.94
|
| Rate for Payer: Healthscope Whirlpool |
$483.97
|
| Rate for Payer: Mclaren Commercial |
$449.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: Nomi Health Commercial |
$409.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.07
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$149.79 |
| Rate for Payer: Aetna Commercial |
$134.81
|
| Rate for Payer: ASR ASR |
$145.30
|
| Rate for Payer: ASR Commercial |
$145.30
|
| Rate for Payer: BCBS Trust/PPO |
$122.06
|
| Rate for Payer: BCN Commercial |
$116.13
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$140.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$149.79
|
| Rate for Payer: Healthscope Whirlpool |
$145.30
|
| Rate for Payer: Mclaren Commercial |
$134.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.82
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$149.79 |
| Rate for Payer: Aetna Commercial |
$134.81
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$145.30
|
| Rate for Payer: ASR Commercial |
$145.30
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$122.66
|
| Rate for Payer: BCN Commercial |
$116.13
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$140.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$149.79
|
| Rate for Payer: Healthscope Whirlpool |
$145.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren Commercial |
$134.81
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.20
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$46.56
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: VA VA |
$69.73
|
|
