|
HC EMBOLIZATION COILS LVL2
|
Facility
|
IP
|
$481.95
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.63 |
| Max. Negotiated Rate |
$433.75 |
| Rate for Payer: Aetna Commercial |
$409.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.27
|
| Rate for Payer: Cash Price |
$385.56
|
| Rate for Payer: Cofinity Advantage |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.56
|
| Rate for Payer: Healthscope Commercial |
$433.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.46
|
| Rate for Payer: PHP Commercial |
$409.66
|
| Rate for Payer: Priority Health SBD |
$303.63
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
OP
|
$481.95
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$433.75 |
| Rate for Payer: Aetna Commercial |
$409.66
|
| Rate for Payer: Aetna Medicare |
$240.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.27
|
| Rate for Payer: BCBS Complete |
$192.78
|
| Rate for Payer: Cash Price |
$385.56
|
| Rate for Payer: Cofinity Advantage |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.56
|
| Rate for Payer: Healthscope Commercial |
$433.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.46
|
| Rate for Payer: PHP Commercial |
$409.66
|
| Rate for Payer: Priority Health SBD |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.27
|
| Rate for Payer: UHC Core |
$251.10
|
| Rate for Payer: UHC Exchange |
$189.41
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
IP
|
$2,366.91
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.15 |
| Max. Negotiated Rate |
$2,130.22 |
| Rate for Payer: Aetna Commercial |
$2,011.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,538.49
|
| Rate for Payer: Cash Price |
$1,893.53
|
| Rate for Payer: Cofinity Advantage |
$1,656.84
|
| Rate for Payer: Cofinity Commercial |
$2,035.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,893.53
|
| Rate for Payer: Healthscope Commercial |
$2,130.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.18
|
| Rate for Payer: PHP Commercial |
$2,011.87
|
| Rate for Payer: Priority Health SBD |
$1,491.15
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
OP
|
$2,366.91
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$930.20 |
| Max. Negotiated Rate |
$2,130.22 |
| Rate for Payer: Aetna Commercial |
$2,011.87
|
| Rate for Payer: Aetna Medicare |
$1,183.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,538.49
|
| Rate for Payer: BCBS Complete |
$946.76
|
| Rate for Payer: Cash Price |
$1,893.53
|
| Rate for Payer: Cofinity Advantage |
$1,656.84
|
| Rate for Payer: Cofinity Commercial |
$2,035.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,893.53
|
| Rate for Payer: Healthscope Commercial |
$2,130.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,893.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.18
|
| Rate for Payer: PHP Commercial |
$2,011.87
|
| Rate for Payer: Priority Health SBD |
$1,491.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,538.49
|
| Rate for Payer: UHC Core |
$1,233.16
|
| Rate for Payer: UHC Exchange |
$930.20
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
OP
|
$18,123.76
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$15,405.20
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,780.44
|
| 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 |
$9,009.64
|
| Rate for Payer: BCN Commercial |
$9,009.64
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$14,499.01
|
| Rate for Payer: Cash Price |
$14,499.01
|
| Rate for Payer: Cash Price |
$14,499.01
|
| Rate for Payer: Cofinity Advantage |
$12,686.63
|
| Rate for Payer: Cofinity Commercial |
$15,586.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,499.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$16,311.38
|
| 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 |
$15,405.20
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,592.82
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$15,405.20
|
| 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 |
$11,417.97
|
| 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 FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
IP
|
$18,123.76
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,417.97 |
| Max. Negotiated Rate |
$16,311.38 |
| Rate for Payer: Aetna Commercial |
$15,405.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,780.44
|
| Rate for Payer: Cash Price |
$14,499.01
|
| Rate for Payer: Cofinity Advantage |
$12,686.63
|
| Rate for Payer: Cofinity Commercial |
$15,586.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,499.01
|
| Rate for Payer: Healthscope Commercial |
$16,311.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,405.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,592.82
|
| Rate for Payer: PHP Commercial |
$15,405.20
|
| Rate for Payer: Priority Health SBD |
$11,417.97
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
OP
|
$5,359.41
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,376.43 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$4,555.50
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,483.62
|
| 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 |
$4,287.53
|
| Rate for Payer: Cash Price |
$4,287.53
|
| Rate for Payer: Cash Price |
$4,287.53
|
| Rate for Payer: Cofinity Advantage |
$3,751.59
|
| Rate for Payer: Cofinity Commercial |
$4,609.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,287.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$4,823.47
|
| 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 |
$4,555.50
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,019.56
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$4,555.50
|
| 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 |
$3,376.43
|
| 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 NON-CNS HEAD OR NECK
|
Facility
|
IP
|
$5,359.41
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,376.43 |
| Max. Negotiated Rate |
$4,823.47 |
| Rate for Payer: Aetna Commercial |
$4,555.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,483.62
|
| Rate for Payer: Cash Price |
$4,287.53
|
| Rate for Payer: Cofinity Advantage |
$3,751.59
|
| Rate for Payer: Cofinity Commercial |
$4,609.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,287.53
|
| Rate for Payer: Healthscope Commercial |
$4,823.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,555.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,019.56
|
| Rate for Payer: PHP Commercial |
$4,555.50
|
| Rate for Payer: Priority Health SBD |
$3,376.43
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
OP
|
$437.34
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.94 |
| Max. Negotiated Rate |
$5,102.80 |
| Rate for Payer: Aetna Commercial |
$371.74
|
| Rate for Payer: Aetna Medicare |
$218.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.27
|
| Rate for Payer: BCBS Complete |
$174.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,102.80
|
| Rate for Payer: BCN Commercial |
$5,102.80
|
| Rate for Payer: Cash Price |
$349.87
|
| Rate for Payer: Cash Price |
$349.87
|
| Rate for Payer: Cofinity Advantage |
$306.14
|
| Rate for Payer: Cofinity Commercial |
$376.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.87
|
| Rate for Payer: Healthscope Commercial |
$393.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.00
|
| Rate for Payer: PHP Commercial |
$371.74
|
| Rate for Payer: Priority Health SBD |
$275.52
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
IP
|
$437.34
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.52 |
| Max. Negotiated Rate |
$393.61 |
| Rate for Payer: Aetna Commercial |
$371.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.27
|
| Rate for Payer: Cash Price |
$349.87
|
| Rate for Payer: Cofinity Advantage |
$306.14
|
| Rate for Payer: Cofinity Commercial |
$376.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.87
|
| Rate for Payer: Healthscope Commercial |
$393.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.00
|
| Rate for Payer: PHP Commercial |
$371.74
|
| Rate for Payer: Priority Health SBD |
$275.52
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$22,634.58
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,259.79 |
| Max. Negotiated Rate |
$20,371.12 |
| Rate for Payer: Aetna Commercial |
$19,239.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,712.48
|
| Rate for Payer: Cash Price |
$18,107.66
|
| Rate for Payer: Cofinity Advantage |
$15,844.21
|
| Rate for Payer: Cofinity Commercial |
$19,465.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,107.66
|
| Rate for Payer: Healthscope Commercial |
$20,371.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,239.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,975.94
|
| Rate for Payer: PHP Commercial |
$19,239.39
|
| Rate for Payer: Priority Health SBD |
$14,259.79
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$22,634.58
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$19,239.39
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,712.48
|
| 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 |
$8,600.79
|
| Rate for Payer: BCN Commercial |
$8,600.79
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$18,107.66
|
| Rate for Payer: Cash Price |
$18,107.66
|
| Rate for Payer: Cash Price |
$18,107.66
|
| Rate for Payer: Cofinity Advantage |
$15,844.21
|
| Rate for Payer: Cofinity Commercial |
$19,465.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,107.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$20,371.12
|
| 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 |
$19,239.39
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,975.94
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$19,239.39
|
| 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 |
$14,259.79
|
| 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 EMBOSHIELD SYSTEM
|
Facility
|
OP
|
$6,020.46
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,366.04 |
| Max. Negotiated Rate |
$5,418.41 |
| Rate for Payer: Aetna Commercial |
$5,117.39
|
| Rate for Payer: Aetna Medicare |
$3,010.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,913.30
|
| Rate for Payer: BCBS Complete |
$2,408.18
|
| Rate for Payer: Cash Price |
$4,816.37
|
| Rate for Payer: Cofinity Advantage |
$4,214.32
|
| Rate for Payer: Cofinity Commercial |
$5,177.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,816.37
|
| Rate for Payer: Healthscope Commercial |
$5,418.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,816.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,117.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,515.35
|
| Rate for Payer: PHP Commercial |
$5,117.39
|
| Rate for Payer: Priority Health SBD |
$3,792.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,913.30
|
| Rate for Payer: UHC Core |
$3,136.66
|
| Rate for Payer: UHC Exchange |
$2,366.04
|
|
|
HC EMBOSHIELD SYSTEM
|
Facility
|
IP
|
$6,020.46
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,792.89 |
| Max. Negotiated Rate |
$5,418.41 |
| Rate for Payer: Aetna Commercial |
$5,117.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,913.30
|
| Rate for Payer: Cash Price |
$4,816.37
|
| Rate for Payer: Cofinity Advantage |
$4,214.32
|
| Rate for Payer: Cofinity Commercial |
$5,177.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,816.37
|
| Rate for Payer: Healthscope Commercial |
$5,418.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,117.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,515.35
|
| Rate for Payer: PHP Commercial |
$5,117.39
|
| Rate for Payer: Priority Health SBD |
$3,792.89
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
OP
|
$358.06
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$304.35
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$133.66
|
| Rate for Payer: BCN Commercial |
$133.66
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$286.45
|
| Rate for Payer: Cash Price |
$286.45
|
| Rate for Payer: Cash Price |
$286.45
|
| Rate for Payer: Cofinity Advantage |
$250.64
|
| Rate for Payer: Cofinity Commercial |
$307.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$322.25
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.35
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.55
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$304.35
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$225.58
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.74
|
| Rate for Payer: UHC Core |
$186.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$140.72
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
IP
|
$358.06
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$225.58 |
| Max. Negotiated Rate |
$322.25 |
| Rate for Payer: Aetna Commercial |
$304.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.74
|
| Rate for Payer: Cash Price |
$286.45
|
| Rate for Payer: Cofinity Advantage |
$250.64
|
| Rate for Payer: Cofinity Commercial |
$307.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.45
|
| Rate for Payer: Healthscope Commercial |
$322.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.55
|
| Rate for Payer: PHP Commercial |
$304.35
|
| Rate for Payer: Priority Health SBD |
$225.58
|
|
|
HC EMG BLADDER
|
Facility
|
OP
|
$372.42
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$316.56
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$30.70
|
| Rate for Payer: BCN Commercial |
$30.70
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$297.94
|
| Rate for Payer: Cash Price |
$297.94
|
| Rate for Payer: Cash Price |
$297.94
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$335.18
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.56
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$316.56
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$234.62
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.07
|
| Rate for Payer: UHC Core |
$194.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$146.36
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC EMG BLADDER
|
Facility
|
IP
|
$372.42
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$234.62 |
| Max. Negotiated Rate |
$335.18 |
| Rate for Payer: Aetna Commercial |
$316.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Cash Price |
$297.94
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.94
|
| Rate for Payer: Healthscope Commercial |
$335.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.56
|
| Rate for Payer: Priority Health SBD |
$234.62
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
IP
|
$251.30
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$158.32 |
| Max. Negotiated Rate |
$226.17 |
| Rate for Payer: Aetna Commercial |
$213.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.34
|
| Rate for Payer: Cash Price |
$201.04
|
| Rate for Payer: Cofinity Advantage |
$175.91
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.04
|
| Rate for Payer: Healthscope Commercial |
$226.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.47
|
| Rate for Payer: PHP Commercial |
$213.60
|
| Rate for Payer: Priority Health SBD |
$158.32
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
OP
|
$251.30
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$226.17 |
| Rate for Payer: Aetna Commercial |
$213.60
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$219.10
|
| Rate for Payer: BCN Commercial |
$219.10
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$201.04
|
| Rate for Payer: Cash Price |
$201.04
|
| Rate for Payer: Cofinity Advantage |
$175.91
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$226.17
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.60
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.47
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$213.60
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$158.32
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.34
|
| Rate for Payer: UHC Core |
$130.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$98.76
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
IP
|
$624.29
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$393.30 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$530.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.79
|
| Rate for Payer: Cash Price |
$499.43
|
| Rate for Payer: Cofinity Advantage |
$437.00
|
| Rate for Payer: Cofinity Commercial |
$536.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.43
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.22
|
| Rate for Payer: PHP Commercial |
$530.65
|
| Rate for Payer: Priority Health SBD |
$393.30
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
OP
|
$624.29
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$199.86 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$530.65
|
| Rate for Payer: Aetna Medicare |
$312.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.79
|
| Rate for Payer: BCBS Complete |
$249.72
|
| Rate for Payer: BCBS Trust/PPO |
$199.86
|
| Rate for Payer: BCN Commercial |
$199.86
|
| Rate for Payer: Cash Price |
$499.43
|
| Rate for Payer: Cash Price |
$499.43
|
| Rate for Payer: Cofinity Advantage |
$437.00
|
| Rate for Payer: Cofinity Commercial |
$536.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.43
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$499.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.22
|
| Rate for Payer: PHP Commercial |
$530.65
|
| Rate for Payer: Priority Health SBD |
$393.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.79
|
| Rate for Payer: UHC Core |
$325.26
|
| Rate for Payer: UHC Exchange |
$245.35
|
|
|
HC EMG NDL GUIDANCE NERVE DEST WITH CHEMODENERVATION
|
Facility
|
IP
|
$224.86
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
92200034
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$141.66 |
| Max. Negotiated Rate |
$202.37 |
| Rate for Payer: Aetna Commercial |
$191.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.16
|
| Rate for Payer: Cash Price |
$179.89
|
| Rate for Payer: Cofinity Advantage |
$157.40
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$202.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.65
|
| Rate for Payer: PHP Commercial |
$191.13
|
| Rate for Payer: Priority Health SBD |
$141.66
|
|
