|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
OP
|
$2,602.17
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$2,211.84
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$109.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$2,081.74
|
| Rate for Payer: Cash Price |
$2,081.74
|
| Rate for Payer: Cofinity Commercial |
$2,237.87
|
| Rate for Payer: Cofinity Commercial |
$1,821.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$2,341.95
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,211.84
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$2,211.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$1,639.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
IP
|
$2,602.17
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,639.37 |
| Max. Negotiated Rate |
$2,341.95 |
| Rate for Payer: Aetna Commercial |
$2,211.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.41
|
| Rate for Payer: Cash Price |
$2,081.74
|
| Rate for Payer: Cofinity Commercial |
$1,821.52
|
| Rate for Payer: Cofinity Commercial |
$2,237.87
|
| Rate for Payer: Healthscope Commercial |
$2,341.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,211.84
|
| Rate for Payer: PHP Commercial |
$2,211.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.52
|
| Rate for Payer: Priority Health SBD |
$1,639.37
|
|
|
HC IR THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$7,341.10
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,624.89 |
| Max. Negotiated Rate |
$6,606.99 |
| Rate for Payer: Aetna Commercial |
$6,239.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,771.72
|
| Rate for Payer: Cash Price |
$5,872.88
|
| Rate for Payer: Cofinity Commercial |
$5,138.77
|
| Rate for Payer: Cofinity Commercial |
$6,313.35
|
| Rate for Payer: Healthscope Commercial |
$6,606.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,239.94
|
| Rate for Payer: PHP Commercial |
$6,239.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,138.77
|
| Rate for Payer: Priority Health SBD |
$4,624.89
|
|
|
HC IR THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$7,341.10
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.94 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$6,239.94
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,771.72
|
| 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 |
$2,559.98
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$5,872.88
|
| Rate for Payer: Cash Price |
$5,872.88
|
| Rate for Payer: Cofinity Commercial |
$6,313.35
|
| Rate for Payer: Cofinity Commercial |
$5,138.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$6,606.99
|
| 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 |
$6,239.94
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$6,239.94
|
| 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 |
$5,138.77
|
| 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 |
$4,624.89
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.03
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$410.94
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$2,356.66
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,484.70 |
| Max. Negotiated Rate |
$2,120.99 |
| Rate for Payer: Aetna Commercial |
$2,003.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.83
|
| Rate for Payer: Cash Price |
$1,885.33
|
| Rate for Payer: Cofinity Commercial |
$1,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,026.73
|
| Rate for Payer: Healthscope Commercial |
$2,120.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.16
|
| Rate for Payer: PHP Commercial |
$2,003.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.66
|
| Rate for Payer: Priority Health SBD |
$1,484.70
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$2,356.66
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.48 |
| Max. Negotiated Rate |
$2,666.70 |
| Rate for Payer: Aetna Commercial |
$2,003.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.83
|
| Rate for Payer: BCBS Complete |
$942.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,666.70
|
| Rate for Payer: Cash Price |
$1,885.33
|
| Rate for Payer: Cash Price |
$1,885.33
|
| Rate for Payer: Cofinity Commercial |
$1,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,026.73
|
| Rate for Payer: Healthscope Commercial |
$2,120.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.16
|
| Rate for Payer: PHP Commercial |
$2,003.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.66
|
| Rate for Payer: Priority Health SBD |
$1,484.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.73
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$232.48
|
|
|
HC IR THROMBECTOMY ARTERIAL GRAFT 2ND AND SUBSEQUENT VESSELS
|
Facility
|
IP
|
$5,605.92
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
36100150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,531.73 |
| Max. Negotiated Rate |
$5,045.33 |
| Rate for Payer: Aetna Commercial |
$4,765.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,643.85
|
| Rate for Payer: Cash Price |
$4,484.74
|
| Rate for Payer: Cofinity Commercial |
$4,821.09
|
| Rate for Payer: Cofinity Commercial |
$3,924.14
|
| Rate for Payer: Healthscope Commercial |
$5,045.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,765.03
|
| Rate for Payer: PHP Commercial |
$4,765.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,924.14
|
| Rate for Payer: Priority Health SBD |
$3,531.73
|
|
|
HC IR THROMBECTOMY ARTERIAL GRAFT 2ND AND SUBSEQUENT VESSELS
|
Facility
|
OP
|
$5,605.92
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
36100150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$5,045.33 |
| Rate for Payer: Aetna Commercial |
$4,765.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,643.85
|
| Rate for Payer: BCBS Complete |
$2,242.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.34
|
| Rate for Payer: Cash Price |
$4,484.74
|
| Rate for Payer: Cash Price |
$4,484.74
|
| Rate for Payer: Cofinity Commercial |
$4,821.09
|
| Rate for Payer: Cofinity Commercial |
$3,924.14
|
| Rate for Payer: Healthscope Commercial |
$5,045.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,765.03
|
| Rate for Payer: PHP Commercial |
$4,765.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,924.14
|
| Rate for Payer: Priority Health SBD |
$3,531.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.73
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$155.21
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY
|
Facility
|
IP
|
$7,296.32
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
36100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,596.68 |
| Max. Negotiated Rate |
$6,566.69 |
| Rate for Payer: Aetna Commercial |
$6,201.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,742.61
|
| Rate for Payer: Cash Price |
$5,837.06
|
| Rate for Payer: Cofinity Commercial |
$6,274.84
|
| Rate for Payer: Cofinity Commercial |
$5,107.42
|
| Rate for Payer: Healthscope Commercial |
$6,566.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,201.87
|
| Rate for Payer: PHP Commercial |
$6,201.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,107.42
|
| Rate for Payer: Priority Health SBD |
$4,596.68
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY
|
Facility
|
OP
|
$7,296.32
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
36100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.92 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$6,201.87
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,742.61
|
| 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 |
$2,147.59
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$5,837.06
|
| Rate for Payer: Cash Price |
$5,837.06
|
| Rate for Payer: Cofinity Commercial |
$5,107.42
|
| Rate for Payer: Cofinity Commercial |
$6,274.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$6,566.69
|
| 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 |
$6,201.87
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$6,201.87
|
| 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 |
$5,107.42
|
| 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 |
$4,596.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.41
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$374.92
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY SUBSEQUENT DAY
|
Facility
|
IP
|
$5,264.30
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
36100153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,316.51 |
| Max. Negotiated Rate |
$4,737.87 |
| Rate for Payer: Aetna Commercial |
$4,474.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,421.80
|
| Rate for Payer: Cash Price |
$4,211.44
|
| Rate for Payer: Cofinity Commercial |
$3,685.01
|
| Rate for Payer: Cofinity Commercial |
$4,527.30
|
| Rate for Payer: Healthscope Commercial |
$4,737.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,474.66
|
| Rate for Payer: PHP Commercial |
$4,474.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,685.01
|
| Rate for Payer: Priority Health SBD |
$3,316.51
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY SUBSEQUENT DAY
|
Facility
|
OP
|
$5,264.30
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
36100153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.17 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$4,474.66
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,421.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$4,211.44
|
| Rate for Payer: Cash Price |
$4,211.44
|
| Rate for Payer: Cofinity Commercial |
$3,685.01
|
| Rate for Payer: Cofinity Commercial |
$4,527.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$4,737.87
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,474.66
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$4,474.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,685.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$3,316.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.99
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$268.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC IR TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$1,763.20
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,110.82 |
| Max. Negotiated Rate |
$1,586.88 |
| Rate for Payer: Aetna Commercial |
$1,498.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,146.08
|
| Rate for Payer: Cash Price |
$1,410.56
|
| Rate for Payer: Cofinity Commercial |
$1,234.24
|
| Rate for Payer: Cofinity Commercial |
$1,516.35
|
| Rate for Payer: Healthscope Commercial |
$1,586.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,498.72
|
| Rate for Payer: PHP Commercial |
$1,498.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,234.24
|
| Rate for Payer: Priority Health SBD |
$1,110.82
|
|
|
HC IR TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$1,763.20
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$653.65 |
| Max. Negotiated Rate |
$1,586.88 |
| Rate for Payer: Aetna Commercial |
$1,498.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,146.08
|
| Rate for Payer: BCBS Complete |
$705.28
|
| Rate for Payer: BCBS Trust/PPO |
$653.65
|
| Rate for Payer: Cash Price |
$1,410.56
|
| Rate for Payer: Cash Price |
$1,410.56
|
| Rate for Payer: Cofinity Commercial |
$1,516.35
|
| Rate for Payer: Cofinity Commercial |
$1,234.24
|
| Rate for Payer: Healthscope Commercial |
$1,586.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,498.72
|
| Rate for Payer: PHP Commercial |
$1,498.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,234.24
|
| Rate for Payer: Priority Health SBD |
$1,110.82
|
|
|
HC IR UNLISTED URINARY SYSTEM
|
Facility
|
IP
|
$2,129.88
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
36100254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,341.82 |
| Max. Negotiated Rate |
$1,916.89 |
| Rate for Payer: Aetna Commercial |
$1,810.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.42
|
| Rate for Payer: Cash Price |
$1,703.90
|
| Rate for Payer: Cofinity Commercial |
$1,490.92
|
| Rate for Payer: Cofinity Commercial |
$1,831.70
|
| Rate for Payer: Healthscope Commercial |
$1,916.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,810.40
|
| Rate for Payer: PHP Commercial |
$1,810.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,490.92
|
| Rate for Payer: Priority Health SBD |
$1,341.82
|
|
|
HC IR UNLISTED URINARY SYSTEM
|
Facility
|
OP
|
$2,129.88
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
36100254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.46 |
| Max. Negotiated Rate |
$1,916.89 |
| Rate for Payer: Aetna Commercial |
$1,810.40
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.42
|
| 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 |
$112.46
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$1,703.90
|
| Rate for Payer: Cash Price |
$1,703.90
|
| Rate for Payer: Cofinity Commercial |
$1,490.92
|
| Rate for Payer: Cofinity Commercial |
$1,831.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$1,916.89
|
| 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 |
$1,810.40
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$1,810.40
|
| 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 |
$1,490.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.30
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.44
|
| Rate for Payer: Priority Health SBD |
$1,341.82
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC IR UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$454.34
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$427.74 |
| Rate for Payer: Aetna Commercial |
$386.19
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$363.47
|
| Rate for Payer: Cash Price |
$363.47
|
| Rate for Payer: Cofinity Commercial |
$318.04
|
| Rate for Payer: Cofinity Commercial |
$390.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$408.91
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.19
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$386.19
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.04
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$286.23
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$133.27
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC IR UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$454.34
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$286.23 |
| Max. Negotiated Rate |
$408.91 |
| Rate for Payer: Aetna Commercial |
$386.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.32
|
| Rate for Payer: Cash Price |
$363.47
|
| Rate for Payer: Cofinity Commercial |
$390.73
|
| Rate for Payer: Cofinity Commercial |
$318.04
|
| Rate for Payer: Healthscope Commercial |
$408.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.19
|
| Rate for Payer: PHP Commercial |
$386.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.04
|
| Rate for Payer: Priority Health SBD |
$286.23
|
|
|
HC IR US GUIDED VASC ACCESS
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.73 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
|
|
HC IR US GUIDED VASC ACCESS
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: BCBS Complete |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$41.92
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Exchange |
$37.66
|
|
|
HC IR VASCULAR UNLISTED PROCEDURE
|
Facility
|
OP
|
$480.78
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
36100114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.31 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$408.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.51
|
| Rate for Payer: BCBS Complete |
$192.31
|
| Rate for Payer: BCBS Trust/PPO |
$344.88
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cofinity Commercial |
$413.47
|
| Rate for Payer: Cofinity Commercial |
$336.55
|
| Rate for Payer: Healthscope Commercial |
$432.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.66
|
| Rate for Payer: PHP Commercial |
$408.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.55
|
| Rate for Payer: Priority Health SBD |
$302.89
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC IR VASCULAR UNLISTED PROCEDURE
|
Facility
|
IP
|
$480.78
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
36100114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.89 |
| Max. Negotiated Rate |
$432.70 |
| Rate for Payer: Aetna Commercial |
$408.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.51
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cofinity Commercial |
$336.55
|
| Rate for Payer: Cofinity Commercial |
$413.47
|
| Rate for Payer: Healthscope Commercial |
$432.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.66
|
| Rate for Payer: PHP Commercial |
$408.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.55
|
| Rate for Payer: Priority Health SBD |
$302.89
|
|
|
HC IR VENOGRAM
|
Facility
|
OP
|
$1,100.68
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
32000203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$99.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$693.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$105.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC IR VENOGRAM
|
Facility
|
IP
|
$1,100.68
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
32000203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.43 |
| Max. Negotiated Rate |
$990.61 |
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health SBD |
$693.43
|
|
|
HC IR VENOGRAM BIL
|
Facility
|
OP
|
$1,400.83
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
32000204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$1,190.71
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$108.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cofinity Commercial |
$980.58
|
| Rate for Payer: Cofinity Commercial |
$1,204.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$1,260.75
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.71
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$1,190.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$882.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
