|
HC IR REVISION TIPS WITH FLUORO
|
Facility
|
OP
|
$11,160.76
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
36100148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.27 |
| Max. Negotiated Rate |
$15,432.16 |
| Rate for Payer: Aetna Commercial |
$9,486.65
|
| Rate for Payer: Aetna Medicare |
$5,289.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,254.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,357.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,357.20
|
| Rate for Payer: BCBS Complete |
$2,921.26
|
| Rate for Payer: BCBS MAPPO |
$5,085.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,511.70
|
| Rate for Payer: BCN Medicare Advantage |
$5,085.76
|
| Rate for Payer: Cash Price |
$8,928.61
|
| Rate for Payer: Cash Price |
$8,928.61
|
| Rate for Payer: Cofinity Commercial |
$7,812.53
|
| Rate for Payer: Cofinity Commercial |
$9,598.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,085.76
|
| Rate for Payer: Healthscope Commercial |
$10,044.68
|
| Rate for Payer: Mclaren Medicaid |
$2,781.91
|
| Rate for Payer: Mclaren Medicare |
$5,085.76
|
| Rate for Payer: Meridian Medicaid |
$2,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,340.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,848.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,486.65
|
| Rate for Payer: PACE Medicare |
$4,831.47
|
| Rate for Payer: PACE SWMI |
$5,085.76
|
| Rate for Payer: PHP Commercial |
$9,486.65
|
| Rate for Payer: PHP Medicare Advantage |
$5,085.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,812.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,432.16
|
| Rate for Payer: Priority Health Medicare |
$5,085.76
|
| Rate for Payer: Priority Health Narrow Network |
$12,345.73
|
| Rate for Payer: Priority Health SBD |
$7,031.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5,085.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.80
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,085.76
|
| Rate for Payer: UHC Exchange |
$355.27
|
| Rate for Payer: UHC Medicare Advantage |
$5,238.33
|
| Rate for Payer: VA VA |
$5,085.76
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
IP
|
$178.68
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.57 |
| Max. Negotiated Rate |
$160.81 |
| Rate for Payer: Aetna Commercial |
$151.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.14
|
| Rate for Payer: Cash Price |
$142.94
|
| Rate for Payer: Cofinity Commercial |
$125.08
|
| Rate for Payer: Cofinity Commercial |
$153.66
|
| Rate for Payer: Healthscope Commercial |
$160.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.88
|
| Rate for Payer: PHP Commercial |
$151.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.08
|
| Rate for Payer: Priority Health SBD |
$112.57
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
OP
|
$178.68
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$151.88
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$103.84
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$142.94
|
| Rate for Payer: Cash Price |
$142.94
|
| Rate for Payer: Cofinity Commercial |
$153.66
|
| Rate for Payer: Cofinity Commercial |
$125.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$160.81
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.88
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$151.88
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$112.57
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$24.56
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC IRRIGATION CONE
|
Facility
|
OP
|
$42.75
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Aetna Commercial |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.79
|
| Rate for Payer: BCBS Complete |
$17.10
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$36.76
|
| Rate for Payer: Healthscope Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.34
|
| Rate for Payer: PHP Commercial |
$36.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.92
|
| Rate for Payer: Priority Health SBD |
$26.93
|
|
|
HC IRRIGATION CONE
|
Facility
|
IP
|
$42.75
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Aetna Commercial |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.79
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$36.76
|
| Rate for Payer: Healthscope Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.34
|
| Rate for Payer: PHP Commercial |
$36.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.92
|
| Rate for Payer: Priority Health SBD |
$26.93
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health SBD |
$223.06
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.32
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health SBD |
$223.06
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$29.14
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
IP
|
$1,921.31
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,210.43 |
| Max. Negotiated Rate |
$1,729.18 |
| Rate for Payer: Aetna Commercial |
$1,633.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.85
|
| Rate for Payer: Cash Price |
$1,537.05
|
| Rate for Payer: Cofinity Commercial |
$1,344.92
|
| Rate for Payer: Cofinity Commercial |
$1,652.33
|
| Rate for Payer: Healthscope Commercial |
$1,729.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,633.11
|
| Rate for Payer: PHP Commercial |
$1,633.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.92
|
| Rate for Payer: Priority Health SBD |
$1,210.43
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
OP
|
$1,921.31
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.95 |
| Max. Negotiated Rate |
$1,729.18 |
| Rate for Payer: Aetna Commercial |
$1,633.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.85
|
| Rate for Payer: BCBS Complete |
$768.52
|
| Rate for Payer: BCBS Trust/PPO |
$84.95
|
| Rate for Payer: Cash Price |
$1,537.05
|
| Rate for Payer: Cash Price |
$1,537.05
|
| Rate for Payer: Cofinity Commercial |
$1,652.33
|
| Rate for Payer: Cofinity Commercial |
$1,344.92
|
| Rate for Payer: Healthscope Commercial |
$1,729.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,633.11
|
| Rate for Payer: PHP Commercial |
$1,633.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.92
|
| Rate for Payer: Priority Health SBD |
$1,210.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.09
|
| Rate for Payer: UHC Exchange |
$94.63
|
|
|
HC IR SHEATH
|
Facility
|
IP
|
$229.50
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.58 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.08
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.65
|
| Rate for Payer: Priority Health SBD |
$144.58
|
|
|
HC IR SHEATH
|
Facility
|
OP
|
$229.50
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.08
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.65
|
| Rate for Payer: Priority Health SBD |
$144.58
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
OP
|
$714.77
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$643.29 |
| Rate for Payer: Aetna Commercial |
$607.55
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.60
|
| 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 |
$98.19
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$571.82
|
| Rate for Payer: Cash Price |
$571.82
|
| Rate for Payer: Cofinity Commercial |
$614.70
|
| Rate for Payer: Cofinity Commercial |
$500.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$643.29
|
| 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 |
$607.55
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$607.55
|
| 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 |
$500.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$450.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$80.22
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
IP
|
$714.77
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$643.29 |
| Rate for Payer: Aetna Commercial |
$607.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.60
|
| Rate for Payer: Cash Price |
$571.82
|
| Rate for Payer: Cofinity Commercial |
$500.34
|
| Rate for Payer: Cofinity Commercial |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$643.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$607.55
|
| Rate for Payer: PHP Commercial |
$607.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.34
|
| Rate for Payer: Priority Health SBD |
$450.31
|
|
|
HC IR SIALOGRAM
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$716.43 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$166.03
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Cofinity Commercial |
$400.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$360.26
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$113.62
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC IR SIALOGRAM
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| 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 |
$400.29
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| 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 SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$956.25
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.44 |
| Max. Negotiated Rate |
$860.62 |
| Rate for Payer: Aetna Commercial |
$812.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.56
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$669.38
|
| Rate for Payer: Cofinity Commercial |
$822.38
|
| Rate for Payer: Healthscope Commercial |
$860.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: PHP Commercial |
$812.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: Priority Health SBD |
$602.44
|
|
|
HC IR SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$956.25
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$812.81
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$299.59
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$822.38
|
| Rate for Payer: Cofinity Commercial |
$669.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$860.62
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$812.81
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$602.44
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.53
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$79.57
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
OP
|
$1,537.29
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$88.74 |
| Max. Negotiated Rate |
$2,899.77 |
| Rate for Payer: Aetna Commercial |
$1,306.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.24
|
| Rate for Payer: BCBS Complete |
$614.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,899.77
|
| Rate for Payer: Cash Price |
$1,229.83
|
| Rate for Payer: Cash Price |
$1,229.83
|
| Rate for Payer: Cofinity Commercial |
$1,076.10
|
| Rate for Payer: Cofinity Commercial |
$1,322.07
|
| Rate for Payer: Healthscope Commercial |
$1,383.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.70
|
| Rate for Payer: PHP Commercial |
$1,306.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.10
|
| Rate for Payer: Priority Health SBD |
$968.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.61
|
| Rate for Payer: UHC Exchange |
$88.74
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
IP
|
$1,537.29
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$968.49 |
| Max. Negotiated Rate |
$1,383.56 |
| Rate for Payer: Aetna Commercial |
$1,306.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.24
|
| Rate for Payer: Cash Price |
$1,229.83
|
| Rate for Payer: Cofinity Commercial |
$1,076.10
|
| Rate for Payer: Cofinity Commercial |
$1,322.07
|
| Rate for Payer: Healthscope Commercial |
$1,383.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.70
|
| Rate for Payer: PHP Commercial |
$1,306.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.10
|
| Rate for Payer: Priority Health SBD |
$968.49
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
OP
|
$3,727.13
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$14,847.89 |
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| 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 |
$220.64
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| 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 |
$3,168.06
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| 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 |
$2,608.99
|
| 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 |
$2,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$245.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
IP
|
$3,727.13
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,348.09 |
| Max. Negotiated Rate |
$3,354.42 |
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,168.06
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.99
|
| Rate for Payer: Priority Health SBD |
$2,348.09
|
|
