|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,156.97 |
| Max. Negotiated Rate |
$1,652.81 |
| Rate for Payer: Aetna Commercial |
$1,560.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.70
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,579.36
|
| Rate for Payer: Cofinity Commercial |
$1,285.52
|
| Rate for Payer: Healthscope Commercial |
$1,652.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: PHP Commercial |
$1,560.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: Priority Health SBD |
$1,156.97
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,652.81 |
| Rate for Payer: Aetna Commercial |
$1,560.99
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.83
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,579.36
|
| Rate for Payer: Cofinity Commercial |
$1,285.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,652.81
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,560.99
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$1,156.97
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$395.88
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$491.34 |
| Max. Negotiated Rate |
$701.91 |
| Rate for Payer: Aetna Commercial |
$662.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.94
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$545.93
|
| Rate for Payer: Cofinity Commercial |
$670.71
|
| Rate for Payer: Healthscope Commercial |
$701.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: PHP Commercial |
$662.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: Priority Health SBD |
$491.34
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,198.89 |
| Rate for Payer: Aetna Commercial |
$662.92
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.89
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$545.93
|
| Rate for Payer: Cofinity Commercial |
$670.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$701.91
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$662.92
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$491.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$321.55
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,161.10 |
| Max. Negotiated Rate |
$14,515.86 |
| Rate for Payer: Aetna Commercial |
$13,709.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,483.67
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$11,290.11
|
| Rate for Payer: Cofinity Commercial |
$13,870.71
|
| Rate for Payer: Healthscope Commercial |
$14,515.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: PHP Commercial |
$13,709.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: Priority Health SBD |
$10,161.10
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.71 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$13,709.42
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,483.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$13,870.71
|
| Rate for Payer: Cofinity Commercial |
$11,290.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$14,515.86
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$13,709.42
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$10,161.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$690.48
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$627.71
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,356.27 |
| Max. Negotiated Rate |
$16,223.25 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,716.79
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$12,618.08
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health SBD |
$11,356.27
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.18 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,716.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,214.74
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$12,618.08
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$11,356.27
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.50
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$453.18
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,711.84 |
| Max. Negotiated Rate |
$6,731.20 |
| Rate for Payer: Aetna Commercial |
$6,357.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,861.42
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$5,235.38
|
| Rate for Payer: Cofinity Commercial |
$6,432.03
|
| Rate for Payer: Healthscope Commercial |
$6,731.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: PHP Commercial |
$6,357.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: Priority Health SBD |
$4,711.84
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,138.52 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: Aetna Commercial |
$6,357.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,861.42
|
| Rate for Payer: BCBS Complete |
$2,991.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,354.05
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$6,432.03
|
| Rate for Payer: Cofinity Commercial |
$5,235.38
|
| Rate for Payer: Healthscope Commercial |
$6,731.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: PHP Commercial |
$6,357.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: Priority Health SBD |
$4,711.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.37
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$1,138.52
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
OP
|
$1,837.50
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,653.75 |
| Rate for Payer: Aetna Commercial |
$1,561.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,194.38
|
| Rate for Payer: BCBS Complete |
$735.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cofinity Commercial |
$1,286.25
|
| Rate for Payer: Cofinity Commercial |
$1,580.25
|
| Rate for Payer: Healthscope Commercial |
$1,653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,561.88
|
| Rate for Payer: PHP Commercial |
$1,561.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.25
|
| Rate for Payer: Priority Health SBD |
$1,157.62
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.62 |
| Max. Negotiated Rate |
$1,653.75 |
| Rate for Payer: Aetna Commercial |
$1,561.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,194.38
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cofinity Commercial |
$1,286.25
|
| Rate for Payer: Cofinity Commercial |
$1,580.25
|
| Rate for Payer: Healthscope Commercial |
$1,653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,561.88
|
| Rate for Payer: PHP Commercial |
$1,561.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.25
|
| Rate for Payer: Priority Health SBD |
$1,157.62
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
IP
|
$472.50
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.68 |
| Max. Negotiated Rate |
$425.25 |
| Rate for Payer: Aetna Commercial |
$401.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.12
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cofinity Commercial |
$330.75
|
| Rate for Payer: Cofinity Commercial |
$406.35
|
| Rate for Payer: Healthscope Commercial |
$425.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.62
|
| Rate for Payer: PHP Commercial |
$401.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.75
|
| Rate for Payer: Priority Health SBD |
$297.68
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
OP
|
$472.50
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$425.25 |
| Rate for Payer: Aetna Commercial |
$401.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.12
|
| Rate for Payer: BCBS Complete |
$189.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cofinity Commercial |
$330.75
|
| Rate for Payer: Cofinity Commercial |
$406.35
|
| Rate for Payer: Healthscope Commercial |
$425.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.62
|
| Rate for Payer: PHP Commercial |
$401.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.75
|
| Rate for Payer: Priority Health SBD |
$297.68
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
OP
|
$2,320.50
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.20 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Aetna Commercial |
$1,972.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.32
|
| Rate for Payer: BCBS Complete |
$928.20
|
| Rate for Payer: Cash Price |
$1,856.40
|
| Rate for Payer: Cofinity Commercial |
$1,624.35
|
| Rate for Payer: Cofinity Commercial |
$1,995.63
|
| Rate for Payer: Healthscope Commercial |
$2,088.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,972.42
|
| Rate for Payer: PHP Commercial |
$1,972.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: Priority Health SBD |
$1,461.92
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
IP
|
$2,320.50
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.92 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Aetna Commercial |
$1,972.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.32
|
| Rate for Payer: Cash Price |
$1,856.40
|
| Rate for Payer: Cofinity Commercial |
$1,624.35
|
| Rate for Payer: Cofinity Commercial |
$1,995.63
|
| Rate for Payer: Healthscope Commercial |
$2,088.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,972.42
|
| Rate for Payer: PHP Commercial |
$1,972.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: Priority Health SBD |
$1,461.92
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
IP
|
$16,922.27
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,661.03 |
| Max. Negotiated Rate |
$15,230.04 |
| Rate for Payer: Aetna Commercial |
$14,383.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,999.48
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cofinity Commercial |
$11,845.59
|
| Rate for Payer: Cofinity Commercial |
$14,553.15
|
| Rate for Payer: Healthscope Commercial |
$15,230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,383.93
|
| Rate for Payer: PHP Commercial |
$14,383.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,845.59
|
| Rate for Payer: Priority Health SBD |
$10,661.03
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
OP
|
$16,922.27
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.42 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$14,383.93
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,999.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$6,830.72
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cofinity Commercial |
$14,553.15
|
| Rate for Payer: Cofinity Commercial |
$11,845.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$15,230.04
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,383.93
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$14,383.93
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,845.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$10,661.03
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.66
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$532.42
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
OP
|
$5,151.29
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.46 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$4,378.60
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cofinity Commercial |
$4,430.11
|
| Rate for Payer: Cofinity Commercial |
$3,605.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$4,636.16
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,378.60
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$4,378.60
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,605.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$3,245.31
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.71
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$882.46
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
IP
|
$5,151.29
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,245.31 |
| Max. Negotiated Rate |
$4,636.16 |
| Rate for Payer: Aetna Commercial |
$4,378.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.34
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cofinity Commercial |
$3,605.90
|
| Rate for Payer: Cofinity Commercial |
$4,430.11
|
| Rate for Payer: Healthscope Commercial |
$4,636.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,378.60
|
| Rate for Payer: PHP Commercial |
$4,378.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,605.90
|
| Rate for Payer: Priority Health SBD |
$3,245.31
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
OP
|
$420.35
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.14 |
| Max. Negotiated Rate |
$6,461.89 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.23
|
| Rate for Payer: BCBS Complete |
$168.14
|
| Rate for Payer: BCBS Trust/PPO |
$6,461.89
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cofinity Commercial |
$294.24
|
| Rate for Payer: Cofinity Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$378.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.30
|
| Rate for Payer: PHP Commercial |
$357.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.24
|
| Rate for Payer: Priority Health SBD |
$264.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.22
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$169.29
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
IP
|
$420.35
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.82 |
| Max. Negotiated Rate |
$378.32 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.23
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cofinity Commercial |
$294.24
|
| Rate for Payer: Cofinity Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$378.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.30
|
| Rate for Payer: PHP Commercial |
$357.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.24
|
| Rate for Payer: Priority Health SBD |
$264.82
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,356.27 |
| Max. Negotiated Rate |
$16,223.25 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,716.79
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$12,618.08
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health SBD |
$11,356.27
|
|
