|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,900.78 |
| Max. Negotiated Rate |
$10,616.58 |
| Rate for Payer: Aetna Commercial |
$9,554.92
|
| Rate for Payer: ASR ASR |
$10,298.08
|
| Rate for Payer: ASR Commercial |
$10,298.08
|
| Rate for Payer: BCBS Trust/PPO |
$8,651.45
|
| Rate for Payer: BCN Commercial |
$8,231.03
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,979.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$10,616.58
|
| Rate for Payer: Healthscope Whirlpool |
$10,298.08
|
| Rate for Payer: Mclaren Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,342.59
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
IP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,455.96 |
| Max. Negotiated Rate |
$6,855.32 |
| Rate for Payer: Aetna Commercial |
$6,169.79
|
| Rate for Payer: ASR ASR |
$6,649.66
|
| Rate for Payer: ASR Commercial |
$6,649.66
|
| Rate for Payer: BCBS Trust/PPO |
$5,586.40
|
| Rate for Payer: BCN Commercial |
$5,314.93
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$6,444.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Healthscope Commercial |
$6,855.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,649.66
|
| Rate for Payer: Mclaren Commercial |
$6,169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: Nomi Health Commercial |
$5,621.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,032.68
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
OP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,742.13 |
| Max. Negotiated Rate |
$6,855.32 |
| Rate for Payer: Aetna Commercial |
$6,169.79
|
| Rate for Payer: Aetna Medicare |
$3,427.66
|
| Rate for Payer: ASR ASR |
$6,649.66
|
| Rate for Payer: ASR Commercial |
$6,649.66
|
| Rate for Payer: BCBS Complete |
$2,742.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,613.82
|
| Rate for Payer: BCN Commercial |
$5,314.93
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$6,444.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Healthscope Commercial |
$6,855.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,649.66
|
| Rate for Payer: Mclaren Commercial |
$6,169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: Nomi Health Commercial |
$5,621.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,006.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,805.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,032.68
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
OP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$24,667.58 |
| Rate for Payer: Aetna Commercial |
$22,200.82
|
| 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 |
$23,927.55
|
| Rate for Payer: ASR Commercial |
$23,927.55
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCBS Trust/PPO |
$20,200.28
|
| Rate for Payer: BCN Commercial |
$19,124.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$23,187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$24,667.58
|
| Rate for Payer: Healthscope Whirlpool |
$23,927.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,060.23
|
| Rate for Payer: Mclaren Commercial |
$22,200.82
|
| 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 |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| 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 |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,613.73
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health Narrow Network |
$17,291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,707.47
|
| 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 STENT VESSEL/BRANCH
|
Facility
|
IP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,033.93 |
| Max. Negotiated Rate |
$24,667.58 |
| Rate for Payer: Aetna Commercial |
$22,200.82
|
| Rate for Payer: ASR ASR |
$23,927.55
|
| Rate for Payer: ASR Commercial |
$23,927.55
|
| Rate for Payer: BCBS Trust/PPO |
$20,101.61
|
| Rate for Payer: BCN Commercial |
$19,124.77
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$23,187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Healthscope Commercial |
$24,667.58
|
| Rate for Payer: Healthscope Whirlpool |
$23,927.55
|
| Rate for Payer: Mclaren Commercial |
$22,200.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,707.47
|
|
|
HC ST JUDE CRT ICD
|
Facility
|
IP
|
$28,090.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500009
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$18,259.02 |
| Max. Negotiated Rate |
$28,090.80 |
| Rate for Payer: Aetna Commercial |
$25,281.72
|
| Rate for Payer: ASR ASR |
$27,248.08
|
| Rate for Payer: ASR Commercial |
$27,248.08
|
| Rate for Payer: BCBS Trust/PPO |
$22,891.19
|
| Rate for Payer: BCN Commercial |
$21,778.80
|
| Rate for Payer: Cash Price |
$22,472.64
|
| Rate for Payer: Cofinity Commercial |
$26,405.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,472.64
|
| Rate for Payer: Healthscope Commercial |
$28,090.80
|
| Rate for Payer: Healthscope Whirlpool |
$27,248.08
|
| Rate for Payer: Mclaren Commercial |
$25,281.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,877.18
|
| Rate for Payer: Nomi Health Commercial |
$23,034.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,259.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24,719.90
|
|
|
HC ST JUDE CRT ICD
|
Facility
|
OP
|
$28,090.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500009
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,236.32 |
| Max. Negotiated Rate |
$28,090.80 |
| Rate for Payer: Aetna Commercial |
$25,281.72
|
| Rate for Payer: Aetna Medicare |
$14,045.40
|
| Rate for Payer: ASR ASR |
$27,248.08
|
| Rate for Payer: ASR Commercial |
$27,248.08
|
| Rate for Payer: BCBS Complete |
$11,236.32
|
| Rate for Payer: BCBS Trust/PPO |
$23,003.56
|
| Rate for Payer: BCN Commercial |
$21,778.80
|
| Rate for Payer: Cash Price |
$22,472.64
|
| Rate for Payer: Cofinity Commercial |
$26,405.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,472.64
|
| Rate for Payer: Healthscope Commercial |
$28,090.80
|
| Rate for Payer: Healthscope Whirlpool |
$27,248.08
|
| Rate for Payer: Mclaren Commercial |
$25,281.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,877.18
|
| Rate for Payer: Nomi Health Commercial |
$23,034.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,259.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,613.16
|
| Rate for Payer: Priority Health Narrow Network |
$19,691.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24,719.90
|
|
|
HC ST JUDE CRT LEAD
|
Facility
|
IP
|
$5,826.24
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,787.06 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$5,243.62
|
| Rate for Payer: ASR ASR |
$5,651.45
|
| Rate for Payer: ASR Commercial |
$5,651.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,747.80
|
| Rate for Payer: BCN Commercial |
$4,517.08
|
| Rate for Payer: Cash Price |
$4,660.99
|
| Rate for Payer: Cofinity Commercial |
$5,476.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.99
|
| Rate for Payer: Healthscope Commercial |
$5,826.24
|
| Rate for Payer: Healthscope Whirlpool |
$5,651.45
|
| Rate for Payer: Mclaren Commercial |
$5,243.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.30
|
| Rate for Payer: Nomi Health Commercial |
$4,777.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,127.09
|
|
|
HC ST JUDE CRT LEAD
|
Facility
|
OP
|
$5,826.24
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,330.50 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$5,243.62
|
| Rate for Payer: Aetna Medicare |
$2,913.12
|
| Rate for Payer: ASR ASR |
$5,651.45
|
| Rate for Payer: ASR Commercial |
$5,651.45
|
| Rate for Payer: BCBS Complete |
$2,330.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,771.11
|
| Rate for Payer: BCN Commercial |
$4,517.08
|
| Rate for Payer: Cash Price |
$4,660.99
|
| Rate for Payer: Cofinity Commercial |
$5,476.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.99
|
| Rate for Payer: Healthscope Commercial |
$5,826.24
|
| Rate for Payer: Healthscope Whirlpool |
$5,651.45
|
| Rate for Payer: Mclaren Commercial |
$5,243.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.30
|
| Rate for Payer: Nomi Health Commercial |
$4,777.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,104.95
|
| Rate for Payer: Priority Health Narrow Network |
$4,084.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,127.09
|
|
|
HC ST JUDE DUAL PACEMAKER
|
Facility
|
IP
|
$9,363.60
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500010
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,086.34 |
| Max. Negotiated Rate |
$9,363.60 |
| Rate for Payer: Aetna Commercial |
$8,427.24
|
| Rate for Payer: ASR ASR |
$9,082.69
|
| Rate for Payer: ASR Commercial |
$9,082.69
|
| Rate for Payer: BCBS Trust/PPO |
$7,630.40
|
| Rate for Payer: BCN Commercial |
$7,259.60
|
| Rate for Payer: Cash Price |
$7,490.88
|
| Rate for Payer: Cofinity Commercial |
$8,801.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,490.88
|
| Rate for Payer: Healthscope Commercial |
$9,363.60
|
| Rate for Payer: Healthscope Whirlpool |
$9,082.69
|
| Rate for Payer: Mclaren Commercial |
$8,427.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,959.06
|
| Rate for Payer: Nomi Health Commercial |
$7,678.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,086.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,239.97
|
|
|
HC ST JUDE DUAL PACEMAKER
|
Facility
|
OP
|
$9,363.60
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500010
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,745.44 |
| Max. Negotiated Rate |
$9,363.60 |
| Rate for Payer: Aetna Commercial |
$8,427.24
|
| Rate for Payer: Aetna Medicare |
$4,681.80
|
| Rate for Payer: ASR ASR |
$9,082.69
|
| Rate for Payer: ASR Commercial |
$9,082.69
|
| Rate for Payer: BCBS Complete |
$3,745.44
|
| Rate for Payer: BCBS Trust/PPO |
$7,667.85
|
| Rate for Payer: BCN Commercial |
$7,259.60
|
| Rate for Payer: Cash Price |
$7,490.88
|
| Rate for Payer: Cofinity Commercial |
$8,801.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,490.88
|
| Rate for Payer: Healthscope Commercial |
$9,363.60
|
| Rate for Payer: Healthscope Whirlpool |
$9,082.69
|
| Rate for Payer: Mclaren Commercial |
$8,427.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,959.06
|
| Rate for Payer: Nomi Health Commercial |
$7,678.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,086.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,204.39
|
| Rate for Payer: Priority Health Narrow Network |
$6,563.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,239.97
|
|
|
HC ST JUDE ICD DUAL
|
Facility
|
OP
|
$21,224.16
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,489.66 |
| Max. Negotiated Rate |
$21,224.16 |
| Rate for Payer: Aetna Commercial |
$19,101.74
|
| Rate for Payer: Aetna Medicare |
$10,612.08
|
| Rate for Payer: ASR ASR |
$20,587.44
|
| Rate for Payer: ASR Commercial |
$20,587.44
|
| Rate for Payer: BCBS Complete |
$8,489.66
|
| Rate for Payer: BCBS Trust/PPO |
$17,380.46
|
| Rate for Payer: BCN Commercial |
$16,455.09
|
| Rate for Payer: Cash Price |
$16,979.33
|
| Rate for Payer: Cofinity Commercial |
$19,950.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,979.33
|
| Rate for Payer: Healthscope Commercial |
$21,224.16
|
| Rate for Payer: Healthscope Whirlpool |
$20,587.44
|
| Rate for Payer: Mclaren Commercial |
$19,101.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,040.54
|
| Rate for Payer: Nomi Health Commercial |
$17,403.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,795.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,596.61
|
| Rate for Payer: Priority Health Narrow Network |
$14,878.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18,677.26
|
|
|
HC ST JUDE ICD DUAL
|
Facility
|
IP
|
$21,224.16
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,795.70 |
| Max. Negotiated Rate |
$21,224.16 |
| Rate for Payer: Aetna Commercial |
$19,101.74
|
| Rate for Payer: ASR ASR |
$20,587.44
|
| Rate for Payer: ASR Commercial |
$20,587.44
|
| Rate for Payer: BCBS Trust/PPO |
$17,295.57
|
| Rate for Payer: BCN Commercial |
$16,455.09
|
| Rate for Payer: Cash Price |
$16,979.33
|
| Rate for Payer: Cofinity Commercial |
$19,950.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,979.33
|
| Rate for Payer: Healthscope Commercial |
$21,224.16
|
| Rate for Payer: Healthscope Whirlpool |
$20,587.44
|
| Rate for Payer: Mclaren Commercial |
$19,101.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,040.54
|
| Rate for Payer: Nomi Health Commercial |
$17,403.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,795.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18,677.26
|
|
|
HC ST JUDE ICD SINGLE
|
Facility
|
OP
|
$14,066.21
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,626.48 |
| Max. Negotiated Rate |
$14,066.21 |
| Rate for Payer: Aetna Commercial |
$12,659.59
|
| Rate for Payer: Aetna Medicare |
$7,033.10
|
| Rate for Payer: ASR ASR |
$13,644.22
|
| Rate for Payer: ASR Commercial |
$13,644.22
|
| Rate for Payer: BCBS Complete |
$5,626.48
|
| Rate for Payer: BCBS Trust/PPO |
$11,518.82
|
| Rate for Payer: BCN Commercial |
$10,905.53
|
| Rate for Payer: Cash Price |
$11,252.97
|
| Rate for Payer: Cofinity Commercial |
$13,222.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,252.97
|
| Rate for Payer: Healthscope Commercial |
$14,066.21
|
| Rate for Payer: Healthscope Whirlpool |
$13,644.22
|
| Rate for Payer: Mclaren Commercial |
$12,659.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,956.28
|
| Rate for Payer: Nomi Health Commercial |
$11,534.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,143.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,324.81
|
| Rate for Payer: Priority Health Narrow Network |
$9,860.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,378.26
|
|
|
HC ST JUDE ICD SINGLE
|
Facility
|
IP
|
$14,066.21
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,143.04 |
| Max. Negotiated Rate |
$14,066.21 |
| Rate for Payer: Aetna Commercial |
$12,659.59
|
| Rate for Payer: ASR ASR |
$13,644.22
|
| Rate for Payer: ASR Commercial |
$13,644.22
|
| Rate for Payer: BCBS Trust/PPO |
$11,462.55
|
| Rate for Payer: BCN Commercial |
$10,905.53
|
| Rate for Payer: Cash Price |
$11,252.97
|
| Rate for Payer: Cofinity Commercial |
$13,222.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,252.97
|
| Rate for Payer: Healthscope Commercial |
$14,066.21
|
| Rate for Payer: Healthscope Whirlpool |
$13,644.22
|
| Rate for Payer: Mclaren Commercial |
$12,659.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,956.28
|
| Rate for Payer: Nomi Health Commercial |
$11,534.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,143.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,378.26
|
|
|
HC ST JUDE SINGLE PACEMAKER
|
Facility
|
OP
|
$7,178.76
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500011
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,871.50 |
| Max. Negotiated Rate |
$7,178.76 |
| Rate for Payer: Aetna Commercial |
$6,460.88
|
| Rate for Payer: Aetna Medicare |
$3,589.38
|
| Rate for Payer: ASR ASR |
$6,963.40
|
| Rate for Payer: ASR Commercial |
$6,963.40
|
| Rate for Payer: BCBS Complete |
$2,871.50
|
| Rate for Payer: BCBS Trust/PPO |
$5,878.69
|
| Rate for Payer: BCN Commercial |
$5,565.69
|
| Rate for Payer: Cash Price |
$5,743.01
|
| Rate for Payer: Cofinity Commercial |
$6,748.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.01
|
| Rate for Payer: Healthscope Commercial |
$7,178.76
|
| Rate for Payer: Healthscope Whirlpool |
$6,963.40
|
| Rate for Payer: Mclaren Commercial |
$6,460.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,101.95
|
| Rate for Payer: Nomi Health Commercial |
$5,886.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,666.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,290.03
|
| Rate for Payer: Priority Health Narrow Network |
$5,032.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,317.31
|
|
|
HC ST JUDE SINGLE PACEMAKER
|
Facility
|
IP
|
$7,178.76
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500011
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,666.19 |
| Max. Negotiated Rate |
$7,178.76 |
| Rate for Payer: Aetna Commercial |
$6,460.88
|
| Rate for Payer: ASR ASR |
$6,963.40
|
| Rate for Payer: ASR Commercial |
$6,963.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,849.97
|
| Rate for Payer: BCN Commercial |
$5,565.69
|
| Rate for Payer: Cash Price |
$5,743.01
|
| Rate for Payer: Cofinity Commercial |
$6,748.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.01
|
| Rate for Payer: Healthscope Commercial |
$7,178.76
|
| Rate for Payer: Healthscope Whirlpool |
$6,963.40
|
| Rate for Payer: Mclaren Commercial |
$6,460.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,101.95
|
| Rate for Payer: Nomi Health Commercial |
$5,886.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,666.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,317.31
|
|
|
HC ST JUDE TACHY (ICD) LEAD
|
Facility
|
OP
|
$8,164.72
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,265.89 |
| Max. Negotiated Rate |
$8,164.72 |
| Rate for Payer: Aetna Commercial |
$7,348.25
|
| Rate for Payer: Aetna Medicare |
$4,082.36
|
| Rate for Payer: ASR ASR |
$7,919.78
|
| Rate for Payer: ASR Commercial |
$7,919.78
|
| Rate for Payer: BCBS Complete |
$3,265.89
|
| Rate for Payer: BCBS Trust/PPO |
$6,686.09
|
| Rate for Payer: BCN Commercial |
$6,330.11
|
| Rate for Payer: Cash Price |
$6,531.78
|
| Rate for Payer: Cofinity Commercial |
$7,674.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,531.78
|
| Rate for Payer: Healthscope Commercial |
$8,164.72
|
| Rate for Payer: Healthscope Whirlpool |
$7,919.78
|
| Rate for Payer: Mclaren Commercial |
$7,348.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,940.01
|
| Rate for Payer: Nomi Health Commercial |
$6,695.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,307.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,153.93
|
| Rate for Payer: Priority Health Narrow Network |
$5,723.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,184.95
|
|
|
HC ST JUDE TACHY (ICD) LEAD
|
Facility
|
IP
|
$8,164.72
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,307.07 |
| Max. Negotiated Rate |
$8,164.72 |
| Rate for Payer: Aetna Commercial |
$7,348.25
|
| Rate for Payer: ASR ASR |
$7,919.78
|
| Rate for Payer: ASR Commercial |
$7,919.78
|
| Rate for Payer: BCBS Trust/PPO |
$6,653.43
|
| Rate for Payer: BCN Commercial |
$6,330.11
|
| Rate for Payer: Cash Price |
$6,531.78
|
| Rate for Payer: Cofinity Commercial |
$7,674.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,531.78
|
| Rate for Payer: Healthscope Commercial |
$8,164.72
|
| Rate for Payer: Healthscope Whirlpool |
$7,919.78
|
| Rate for Payer: Mclaren Commercial |
$7,348.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,940.01
|
| Rate for Payer: Nomi Health Commercial |
$6,695.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,307.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,184.95
|
|
|
HC STOOL CULTURE
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
30600073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: ASR Commercial |
$38.75
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$30.97
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$39.95
|
| Rate for Payer: Healthscope Whirlpool |
$38.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicaid |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.00
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow Network |
$28.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Exchange |
$14.63
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP DNSP |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC STOOL CULTURE
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
30600073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: ASR Commercial |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$30.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$39.95
|
| Rate for Payer: Healthscope Whirlpool |
$38.75
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
HC STOOL CULTURE CMPT
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
30600074
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: ASR Commercial |
$38.75
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$30.97
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$39.95
|
| Rate for Payer: Healthscope Whirlpool |
$38.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicaid |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.00
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow Network |
$28.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Exchange |
$14.63
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP DNSP |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC STOOL CULTURE CMPT
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
30600074
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: ASR Commercial |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$30.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$39.95
|
| Rate for Payer: Healthscope Whirlpool |
$38.75
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
HC STOOL CULTURE CMPT2
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600069
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: ASR ASR |
$12.92
|
| Rate for Payer: ASR Commercial |
$12.92
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Healthscope Whirlpool |
$12.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$11.99
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.35
|
| Rate for Payer: PHP Medicaid |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.67
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$9.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: UHCCP DNSP |
$6.68
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC STOOL CULTURE CMPT2
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600069
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: ASR ASR |
$12.92
|
| Rate for Payer: ASR Commercial |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$10.85
|
| Rate for Payer: BCN Commercial |
$10.33
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Healthscope Whirlpool |
$12.92
|
| Rate for Payer: Mclaren Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.72
|
|
