|
HC ELECTROPHYSIOLOGY CATHS NO 3D 20 OR > ELECTRODES LEVEL 46
|
Facility
|
OP
|
$4,888.23
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$4,399.41 |
| Rate for Payer: Aetna Commercial |
$4,155.00
|
| Rate for Payer: Aetna Medicare |
$2,444.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,177.35
|
| Rate for Payer: BCBS Complete |
$1,955.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,910.58
|
| Rate for Payer: Cash Price |
$3,910.58
|
| Rate for Payer: Cofinity Advantage |
$3,421.76
|
| Rate for Payer: Cofinity Commercial |
$4,203.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,910.58
|
| Rate for Payer: Healthscope Commercial |
$4,399.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,910.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,155.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,666.17
|
| Rate for Payer: PHP Commercial |
$4,155.00
|
| Rate for Payer: Priority Health SBD |
$3,079.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,177.35
|
| Rate for Payer: UHC Core |
$2,546.77
|
| Rate for Payer: UHC Exchange |
$1,921.07
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$272.27
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.98
|
| Rate for Payer: Cash Price |
$217.82
|
| Rate for Payer: Cofinity Advantage |
$190.59
|
| Rate for Payer: Cofinity Commercial |
$234.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.82
|
| Rate for Payer: Healthscope Commercial |
$245.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.20
|
| Rate for Payer: PHP Commercial |
$231.43
|
| Rate for Payer: Priority Health SBD |
$171.53
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
OP
|
$272.27
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$231.43
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.98
|
| Rate for Payer: BCBS Complete |
$108.91
|
| Rate for Payer: Cash Price |
$217.82
|
| Rate for Payer: Cofinity Advantage |
$190.59
|
| Rate for Payer: Cofinity Commercial |
$234.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.82
|
| Rate for Payer: Healthscope Commercial |
$245.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.20
|
| Rate for Payer: PHP Commercial |
$231.43
|
| Rate for Payer: Priority Health SBD |
$171.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.98
|
| Rate for Payer: UHC Core |
$141.85
|
| Rate for Payer: UHC Exchange |
$107.00
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$28,474.35
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,938.84 |
| Max. Negotiated Rate |
$25,626.92 |
| Rate for Payer: Aetna Commercial |
$24,203.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,508.33
|
| Rate for Payer: Cash Price |
$22,779.48
|
| Rate for Payer: Cofinity Advantage |
$19,932.04
|
| Rate for Payer: Cofinity Commercial |
$24,487.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,779.48
|
| Rate for Payer: Healthscope Commercial |
$25,626.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,203.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,355.76
|
| Rate for Payer: PHP Commercial |
$24,203.20
|
| Rate for Payer: Priority Health SBD |
$17,938.84
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$28,474.35
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,064.56 |
| Max. Negotiated Rate |
$25,626.92 |
| Rate for Payer: Aetna Commercial |
$24,203.20
|
| Rate for Payer: Aetna Medicare |
$8,082.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,508.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,714.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,714.52
|
| Rate for Payer: BCBS Complete |
$4,268.17
|
| Rate for Payer: BCBS MAPPO |
$7,771.62
|
| Rate for Payer: BCBS Trust/PPO |
$21,092.64
|
| Rate for Payer: BCN Commercial |
$21,092.64
|
| Rate for Payer: BCN Medicare Advantage |
$7,771.62
|
| Rate for Payer: Cash Price |
$22,779.48
|
| Rate for Payer: Cash Price |
$22,779.48
|
| Rate for Payer: Cofinity Advantage |
$19,932.04
|
| Rate for Payer: Cofinity Commercial |
$24,487.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,779.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,771.62
|
| Rate for Payer: Healthscope Commercial |
$25,626.92
|
| Rate for Payer: Mclaren Medicaid |
$4,064.56
|
| Rate for Payer: Mclaren Medicare |
$7,771.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,160.20
|
| Rate for Payer: Meridian Medicaid |
$8,160.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,937.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,548.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,203.20
|
| Rate for Payer: Nomi Health Commercial |
$23,314.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,355.76
|
| Rate for Payer: PACE Medicare |
$7,383.04
|
| Rate for Payer: PACE SWMI |
$7,771.62
|
| Rate for Payer: PHP Commercial |
$24,203.20
|
| Rate for Payer: PHP Medicare Advantage |
$7,771.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,064.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,132.71
|
| Rate for Payer: Priority Health Medicare |
$7,771.62
|
| Rate for Payer: Priority Health SBD |
$17,938.84
|
| Rate for Payer: Priority Health Tiered Network |
$20,106.17
|
| Rate for Payer: Railroad Medicare Medicare |
$7,771.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,771.62
|
| Rate for Payer: UHC Medicaid |
$4,064.56
|
| Rate for Payer: UHCCP Medicaid |
$4,064.56
|
| Rate for Payer: VA VA |
$7,771.62
|
|
|
HC ELM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$12,094.65
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,619.63 |
| Max. Negotiated Rate |
$10,885.18 |
| Rate for Payer: Aetna Commercial |
$10,280.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,861.52
|
| Rate for Payer: Cash Price |
$9,675.72
|
| Rate for Payer: Cofinity Advantage |
$8,466.25
|
| Rate for Payer: Cofinity Commercial |
$10,401.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,675.72
|
| Rate for Payer: Healthscope Commercial |
$10,885.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,280.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,070.99
|
| Rate for Payer: PHP Commercial |
$10,280.45
|
| Rate for Payer: Priority Health SBD |
$7,619.63
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$12,094.65
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,753.20 |
| Max. Negotiated Rate |
$10,885.18 |
| Rate for Payer: Aetna Commercial |
$10,280.45
|
| Rate for Payer: Aetna Medicare |
$6,047.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,861.52
|
| Rate for Payer: BCBS Complete |
$4,837.86
|
| Rate for Payer: Cash Price |
$9,675.72
|
| Rate for Payer: Cofinity Advantage |
$8,466.25
|
| Rate for Payer: Cofinity Commercial |
$10,401.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,675.72
|
| Rate for Payer: Healthscope Commercial |
$10,885.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,675.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,280.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,070.99
|
| Rate for Payer: PHP Commercial |
$10,280.45
|
| Rate for Payer: Priority Health SBD |
$7,619.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,861.52
|
| Rate for Payer: UHC Core |
$6,301.31
|
| Rate for Payer: UHC Exchange |
$4,753.20
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,769.13
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,267.27 |
| Max. Negotiated Rate |
$5,192.22 |
| Rate for Payer: Aetna Commercial |
$4,903.76
|
| Rate for Payer: Aetna Medicare |
$2,884.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,749.93
|
| Rate for Payer: BCBS Complete |
$2,307.65
|
| Rate for Payer: Cash Price |
$4,615.30
|
| Rate for Payer: Cofinity Advantage |
$4,038.39
|
| Rate for Payer: Cofinity Commercial |
$4,961.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,615.30
|
| Rate for Payer: Healthscope Commercial |
$5,192.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,615.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,903.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,326.85
|
| Rate for Payer: PHP Commercial |
$4,903.76
|
| Rate for Payer: Priority Health SBD |
$3,634.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,749.93
|
| Rate for Payer: UHC Core |
$3,005.72
|
| Rate for Payer: UHC Exchange |
$2,267.27
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,769.13
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,634.55 |
| Max. Negotiated Rate |
$5,192.22 |
| Rate for Payer: Aetna Commercial |
$4,903.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,749.93
|
| Rate for Payer: Cash Price |
$4,615.30
|
| Rate for Payer: Cofinity Advantage |
$4,038.39
|
| Rate for Payer: Cofinity Commercial |
$4,961.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,615.30
|
| Rate for Payer: Healthscope Commercial |
$5,192.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,903.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,326.85
|
| Rate for Payer: PHP Commercial |
$4,903.76
|
| Rate for Payer: Priority Health SBD |
$3,634.55
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$2,087.38
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,878.64 |
| Rate for Payer: Aetna Commercial |
$1,774.27
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.87
|
| Rate for Payer: BCN Commercial |
$1,222.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,669.90
|
| Rate for Payer: Cash Price |
$1,669.90
|
| Rate for Payer: Cofinity Advantage |
$1,461.17
|
| Rate for Payer: Cofinity Commercial |
$1,795.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,669.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,878.64
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.27
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,565.54
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,774.27
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$1,315.05
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,356.80
|
| Rate for Payer: UHC Core |
$1,087.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$820.34
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$2,087.38
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,315.05 |
| Max. Negotiated Rate |
$1,878.64 |
| Rate for Payer: Aetna Commercial |
$1,774.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.80
|
| Rate for Payer: Cash Price |
$1,669.90
|
| Rate for Payer: Cofinity Advantage |
$1,461.17
|
| Rate for Payer: Cofinity Commercial |
$1,795.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,669.90
|
| Rate for Payer: Healthscope Commercial |
$1,878.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,565.54
|
| Rate for Payer: PHP Commercial |
$1,774.27
|
| Rate for Payer: Priority Health SBD |
$1,315.05
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$954.60
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,042.25 |
| Rate for Payer: Aetna Commercial |
$811.41
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.25
|
| Rate for Payer: BCN Commercial |
$1,042.25
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$763.68
|
| Rate for Payer: Cash Price |
$763.68
|
| Rate for Payer: Cofinity Advantage |
$668.22
|
| Rate for Payer: Cofinity Commercial |
$820.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$859.14
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.41
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.95
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$811.41
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$601.40
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.49
|
| Rate for Payer: UHC Core |
$497.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$375.16
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$954.60
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.40 |
| Max. Negotiated Rate |
$859.14 |
| Rate for Payer: Aetna Commercial |
$811.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.49
|
| Rate for Payer: Cash Price |
$763.68
|
| Rate for Payer: Cofinity Advantage |
$668.22
|
| Rate for Payer: Cofinity Commercial |
$820.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.68
|
| Rate for Payer: Healthscope Commercial |
$859.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.95
|
| Rate for Payer: PHP Commercial |
$811.41
|
| Rate for Payer: Priority Health SBD |
$601.40
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$17,117.92
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$14,550.23
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,126.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,695.86
|
| Rate for Payer: BCN Commercial |
$6,695.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$13,694.34
|
| Rate for Payer: Cash Price |
$13,694.34
|
| Rate for Payer: Cash Price |
$13,694.34
|
| Rate for Payer: Cofinity Advantage |
$11,982.54
|
| Rate for Payer: Cofinity Commercial |
$14,721.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,694.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$15,406.13
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,550.23
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,838.44
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$14,550.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$10,784.29
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$17,117.92
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,784.29 |
| Max. Negotiated Rate |
$15,406.13 |
| Rate for Payer: Aetna Commercial |
$14,550.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,126.65
|
| Rate for Payer: Cash Price |
$13,694.34
|
| Rate for Payer: Cofinity Advantage |
$11,982.54
|
| Rate for Payer: Cofinity Commercial |
$14,721.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,694.34
|
| Rate for Payer: Healthscope Commercial |
$15,406.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,550.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,838.44
|
| Rate for Payer: PHP Commercial |
$14,550.23
|
| Rate for Payer: Priority Health SBD |
$10,784.29
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,754.08
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,815.07 |
| Max. Negotiated Rate |
$16,878.67 |
| Rate for Payer: Aetna Commercial |
$15,940.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,190.15
|
| Rate for Payer: Cash Price |
$15,003.26
|
| Rate for Payer: Cofinity Advantage |
$13,127.86
|
| Rate for Payer: Cofinity Commercial |
$16,128.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,003.26
|
| Rate for Payer: Healthscope Commercial |
$16,878.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,940.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,065.56
|
| Rate for Payer: PHP Commercial |
$15,940.97
|
| Rate for Payer: Priority Health SBD |
$11,815.07
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,754.08
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,516.16 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$15,940.97
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,190.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$9,516.16
|
| Rate for Payer: BCN Commercial |
$9,516.16
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$15,003.26
|
| Rate for Payer: Cash Price |
$15,003.26
|
| Rate for Payer: Cash Price |
$15,003.26
|
| Rate for Payer: Cofinity Advantage |
$13,127.86
|
| Rate for Payer: Cofinity Commercial |
$16,128.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,003.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$16,878.67
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,940.97
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,065.56
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$15,940.97
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$11,815.07
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,781.26
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,104.96 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$6,614.07
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,057.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,104.96
|
| Rate for Payer: BCN Commercial |
$3,104.96
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$6,225.01
|
| Rate for Payer: Cash Price |
$6,225.01
|
| Rate for Payer: Cash Price |
$6,225.01
|
| Rate for Payer: Cofinity Advantage |
$5,446.88
|
| Rate for Payer: Cofinity Commercial |
$6,691.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,225.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$7,003.13
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,614.07
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,835.94
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$6,614.07
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$4,902.19
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,781.26
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,902.19 |
| Max. Negotiated Rate |
$7,003.13 |
| Rate for Payer: Aetna Commercial |
$6,614.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,057.82
|
| Rate for Payer: Cash Price |
$6,225.01
|
| Rate for Payer: Cofinity Advantage |
$5,446.88
|
| Rate for Payer: Cofinity Commercial |
$6,691.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,225.01
|
| Rate for Payer: Healthscope Commercial |
$7,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,614.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,835.94
|
| Rate for Payer: PHP Commercial |
$6,614.07
|
| Rate for Payer: Priority Health SBD |
$4,902.19
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
OP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.58 |
| Max. Negotiated Rate |
$1,686.83 |
| Rate for Payer: Aetna Commercial |
$1,593.11
|
| Rate for Payer: Aetna Medicare |
$937.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,218.26
|
| Rate for Payer: BCBS Complete |
$749.70
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cofinity Advantage |
$1,311.97
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,686.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,499.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,405.69
|
| Rate for Payer: PHP Commercial |
$1,593.11
|
| Rate for Payer: Priority Health SBD |
$1,180.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.26
|
| Rate for Payer: UHC Core |
$976.48
|
| Rate for Payer: UHC Exchange |
$736.58
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
IP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.78 |
| Max. Negotiated Rate |
$1,686.83 |
| Rate for Payer: Aetna Commercial |
$1,593.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,218.26
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cofinity Advantage |
$1,311.97
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,686.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,405.69
|
| Rate for Payer: PHP Commercial |
$1,593.11
|
| Rate for Payer: Priority Health SBD |
$1,180.78
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
OP
|
$160.65
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna Medicare |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.42
|
| Rate for Payer: UHC Core |
$83.70
|
| Rate for Payer: UHC Exchange |
$63.14
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
IP
|
$160.65
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.21 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
|
