|
HC IR LYMPHATIC SYSTEM UNLISTED P
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
36100188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.26 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.70
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Cofinity Commercial |
$400.29
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health SBD |
$360.26
|
|
|
HC IR MESENTERIC VISCERAL ANGIOGR
|
Facility
|
OP
|
$3,602.41
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
32000193
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$14,847.89 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,341.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$128.52
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Cofinity Commercial |
$2,521.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,847.89
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$11,878.31
|
| Rate for Payer: Priority Health SBD |
$2,269.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$166.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC IR MESENTERIC VISCERAL ANGIOGR
|
Facility
|
IP
|
$3,602.41
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
32000193
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,269.52 |
| Max. Negotiated Rate |
$3,242.17 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,341.57
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$2,521.69
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health SBD |
$2,269.52
|
|
|
HC IR MYELOGRAM LUMBAR
|
Facility
|
IP
|
$900.70
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
32000055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$567.44 |
| Max. Negotiated Rate |
$810.63 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.46
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$630.49
|
| Rate for Payer: Cofinity Commercial |
$774.60
|
| Rate for Payer: Healthscope Commercial |
$810.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: PHP Commercial |
$765.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: Priority Health SBD |
$567.44
|
|
|
HC IR MYELOGRAM LUMBAR
|
Facility
|
OP
|
$900.70
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
32000055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.07 |
| Max. Negotiated Rate |
$2,221.16 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$116.39
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$774.60
|
| Rate for Payer: Cofinity Commercial |
$630.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$810.63
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$765.60
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.16
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.93
|
| Rate for Payer: Priority Health SBD |
$567.44
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$107.07
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC IR MYELOGRAM THORACIC
|
Facility
|
OP
|
$993.28
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$2,221.16 |
| Rate for Payer: Aetna Commercial |
$844.29
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$122.45
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$794.62
|
| Rate for Payer: Cash Price |
$794.62
|
| Rate for Payer: Cofinity Commercial |
$854.22
|
| Rate for Payer: Cofinity Commercial |
$695.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$893.95
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$844.29
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$844.29
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.16
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.93
|
| Rate for Payer: Priority Health SBD |
$625.77
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$105.76
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC IR MYELOGRAM THORACIC
|
Facility
|
IP
|
$993.28
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$625.77 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Aetna Commercial |
$844.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.63
|
| Rate for Payer: Cash Price |
$794.62
|
| Rate for Payer: Cofinity Commercial |
$695.30
|
| Rate for Payer: Cofinity Commercial |
$854.22
|
| Rate for Payer: Healthscope Commercial |
$893.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$844.29
|
| Rate for Payer: PHP Commercial |
$844.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.30
|
| Rate for Payer: Priority Health SBD |
$625.77
|
|
|
HC IR MYELOGRAM TWO OR MORE REGIO
|
Facility
|
OP
|
$1,334.17
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
32000056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$2,221.16 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$164.37
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$933.92
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.16
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.93
|
| Rate for Payer: Priority Health SBD |
$840.53
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC IR MYELOGRAM TWO OR MORE REGIO
|
Facility
|
IP
|
$1,334.17
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
32000056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$840.53 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.21
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Cofinity Commercial |
$933.92
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health SBD |
$840.53
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$45.03
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
30100268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Medicare |
$9.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.92
|
| Rate for Payer: BCBS Complete |
$5.02
|
| Rate for Payer: BCBS MAPPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$38.73
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$40.53
|
| Rate for Payer: Mclaren Medicaid |
$4.78
|
| Rate for Payer: Mclaren Medicare |
$8.74
|
| Rate for Payer: Meridian Medicaid |
$5.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: PACE Medicare |
$8.30
|
| Rate for Payer: PACE SWMI |
$8.74
|
| Rate for Payer: PHP Commercial |
$38.28
|
| Rate for Payer: PHP Medicare Advantage |
$8.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health Medicare |
$8.74
|
| Rate for Payer: Priority Health SBD |
$28.37
|
| Rate for Payer: Railroad Medicare Medicare |
$8.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.49
|
| Rate for Payer: UHC Core |
$14.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.74
|
| Rate for Payer: UHC Exchange |
$8.74
|
| Rate for Payer: UHC Medicare Advantage |
$9.00
|
| Rate for Payer: VA VA |
$8.74
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
IP
|
$45.03
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
30100268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.27
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$38.73
|
| Rate for Payer: Healthscope Commercial |
$40.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: PHP Commercial |
$38.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health SBD |
$28.37
|
|
|
HC IRON LEVEL
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
30100267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Core |
$11.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC IRON LEVEL
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
30100267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
IP
|
$564.95
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.92 |
| Max. Negotiated Rate |
$508.46 |
| Rate for Payer: Aetna Commercial |
$480.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.22
|
| Rate for Payer: Cash Price |
$451.96
|
| Rate for Payer: Cofinity Commercial |
$485.86
|
| Rate for Payer: Cofinity Commercial |
$395.46
|
| Rate for Payer: Healthscope Commercial |
$508.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.21
|
| Rate for Payer: PHP Commercial |
$480.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.46
|
| Rate for Payer: Priority Health SBD |
$355.92
|
|
|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
OP
|
$564.95
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$508.46 |
| Rate for Payer: Aetna Commercial |
$480.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.22
|
| Rate for Payer: BCBS Complete |
$225.98
|
| Rate for Payer: BCBS Trust/PPO |
$97.63
|
| Rate for Payer: Cash Price |
$451.96
|
| Rate for Payer: Cash Price |
$451.96
|
| Rate for Payer: Cofinity Commercial |
$395.46
|
| Rate for Payer: Cofinity Commercial |
$485.86
|
| Rate for Payer: Healthscope Commercial |
$508.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.21
|
| Rate for Payer: PHP Commercial |
$480.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.46
|
| Rate for Payer: Priority Health SBD |
$355.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.02
|
| Rate for Payer: UHC Exchange |
$93.65
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
OP
|
$11,409.19
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.89 |
| Max. Negotiated Rate |
$10,268.27 |
| Rate for Payer: Aetna Commercial |
$9,697.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,415.97
|
| Rate for Payer: BCBS Complete |
$4,563.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.44
|
| Rate for Payer: Cash Price |
$9,127.35
|
| Rate for Payer: Cash Price |
$9,127.35
|
| Rate for Payer: Cofinity Commercial |
$7,986.43
|
| Rate for Payer: Cofinity Commercial |
$9,811.90
|
| Rate for Payer: Healthscope Commercial |
$10,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,697.81
|
| Rate for Payer: PHP Commercial |
$9,697.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,986.43
|
| Rate for Payer: Priority Health SBD |
$7,187.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.98
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$950.89
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
IP
|
$11,409.19
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,187.79 |
| Max. Negotiated Rate |
$10,268.27 |
| Rate for Payer: Aetna Commercial |
$9,697.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,415.97
|
| Rate for Payer: Cash Price |
$9,127.35
|
| Rate for Payer: Cofinity Commercial |
$7,986.43
|
| Rate for Payer: Cofinity Commercial |
$9,811.90
|
| Rate for Payer: Healthscope Commercial |
$10,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,697.81
|
| Rate for Payer: PHP Commercial |
$9,697.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,986.43
|
| Rate for Payer: Priority Health SBD |
$7,187.79
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
IP
|
$3,389.80
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,135.57 |
| Max. Negotiated Rate |
$3,050.82 |
| Rate for Payer: Aetna Commercial |
$2,881.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,203.37
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cofinity Commercial |
$2,372.86
|
| Rate for Payer: Cofinity Commercial |
$2,915.23
|
| Rate for Payer: Healthscope Commercial |
$3,050.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,881.33
|
| Rate for Payer: PHP Commercial |
$2,881.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.86
|
| Rate for Payer: Priority Health SBD |
$2,135.57
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
OP
|
$3,389.80
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,355.92 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$2,881.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,203.37
|
| Rate for Payer: BCBS Complete |
$1,355.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,942.74
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cash Price |
$2,711.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.23
|
| Rate for Payer: Cofinity Commercial |
$2,372.86
|
| Rate for Payer: Healthscope Commercial |
$3,050.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,881.33
|
| Rate for Payer: PHP Commercial |
$2,881.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.86
|
| Rate for Payer: Priority Health SBD |
$2,135.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,601.03
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$1,455.48
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
OP
|
$5,296.04
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.75 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: Aetna Commercial |
$4,501.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,442.43
|
| Rate for Payer: BCBS Complete |
$2,118.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.35
|
| Rate for Payer: Cash Price |
$4,236.83
|
| Rate for Payer: Cash Price |
$4,236.83
|
| Rate for Payer: Cofinity Commercial |
$4,554.59
|
| Rate for Payer: Cofinity Commercial |
$3,707.23
|
| Rate for Payer: Healthscope Commercial |
$4,766.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.63
|
| Rate for Payer: PHP Commercial |
$4,501.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.23
|
| Rate for Payer: Priority Health SBD |
$3,336.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.12
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$773.75
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
IP
|
$5,296.04
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,336.51 |
| Max. Negotiated Rate |
$4,766.44 |
| Rate for Payer: Aetna Commercial |
$4,501.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,442.43
|
| Rate for Payer: Cash Price |
$4,236.83
|
| Rate for Payer: Cofinity Commercial |
$3,707.23
|
| Rate for Payer: Cofinity Commercial |
$4,554.59
|
| Rate for Payer: Healthscope Commercial |
$4,766.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.63
|
| Rate for Payer: PHP Commercial |
$4,501.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.23
|
| Rate for Payer: Priority Health SBD |
$3,336.51
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
IP
|
$10,080.22
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,350.54 |
| Max. Negotiated Rate |
$9,072.20 |
| Rate for Payer: Aetna Commercial |
$8,568.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,552.14
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cofinity Commercial |
$7,056.15
|
| Rate for Payer: Cofinity Commercial |
$8,668.99
|
| Rate for Payer: Healthscope Commercial |
$9,072.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,568.19
|
| Rate for Payer: PHP Commercial |
$8,568.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,056.15
|
| Rate for Payer: Priority Health SBD |
$6,350.54
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
OP
|
$10,080.22
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,138.00 |
| Max. Negotiated Rate |
$9,072.20 |
| Rate for Payer: Aetna Commercial |
$8,568.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,552.14
|
| Rate for Payer: BCBS Complete |
$4,032.09
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cofinity Commercial |
$8,668.99
|
| Rate for Payer: Cofinity Commercial |
$7,056.15
|
| Rate for Payer: Healthscope Commercial |
$9,072.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,568.19
|
| Rate for Payer: PHP Commercial |
$8,568.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,056.15
|
| Rate for Payer: Priority Health SBD |
$6,350.54
|
| Rate for Payer: UHC Core |
$3,138.00
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
OP
|
$10,080.22
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,138.00 |
| Max. Negotiated Rate |
$9,072.20 |
| Rate for Payer: Aetna Commercial |
$8,568.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,552.14
|
| Rate for Payer: BCBS Complete |
$4,032.09
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cofinity Commercial |
$8,668.99
|
| Rate for Payer: Cofinity Commercial |
$7,056.15
|
| Rate for Payer: Healthscope Commercial |
$9,072.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,568.19
|
| Rate for Payer: PHP Commercial |
$8,568.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,056.15
|
| Rate for Payer: Priority Health SBD |
$6,350.54
|
| Rate for Payer: UHC Core |
$3,138.00
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
IP
|
$10,080.22
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,350.54 |
| Max. Negotiated Rate |
$9,072.20 |
| Rate for Payer: Aetna Commercial |
$8,568.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,552.14
|
| Rate for Payer: Cash Price |
$8,064.18
|
| Rate for Payer: Cofinity Commercial |
$7,056.15
|
| Rate for Payer: Cofinity Commercial |
$8,668.99
|
| Rate for Payer: Healthscope Commercial |
$9,072.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,568.19
|
| Rate for Payer: PHP Commercial |
$8,568.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,056.15
|
| Rate for Payer: Priority Health SBD |
$6,350.54
|
|
