|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.85 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna Medicare |
$209.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.36 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna Medicare |
$269.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,743.00 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna Medicare |
$5,928.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.23
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,470.23 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.23
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,563.29 |
| Max. Negotiated Rate |
$5,090.41 |
| Rate for Payer: Aetna Commercial |
$4,807.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,676.41
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$3,959.21
|
| Rate for Payer: Cofinity Commercial |
$4,864.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,959.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Healthscope Commercial |
$5,090.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: PHP Commercial |
$4,807.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: Priority Health SBD |
$3,563.29
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$5,090.41 |
| Rate for Payer: Aetna Commercial |
$4,807.61
|
| Rate for Payer: Aetna Medicare |
$2,828.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,676.41
|
| Rate for Payer: BCBS Complete |
$2,262.40
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$3,959.21
|
| Rate for Payer: Cofinity Commercial |
$4,864.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,959.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Healthscope Commercial |
$5,090.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: PHP Commercial |
$4,807.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: Priority Health SBD |
$3,563.29
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,289.26 |
| Max. Negotiated Rate |
$1,841.81 |
| Rate for Payer: Aetna Commercial |
$1,739.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.19
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,432.52
|
| Rate for Payer: Cofinity Commercial |
$1,759.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,432.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Healthscope Commercial |
$1,841.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: PHP Commercial |
$1,739.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health SBD |
$1,289.26
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,841.81 |
| Rate for Payer: Aetna Commercial |
$1,739.48
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,759.95
|
| Rate for Payer: Cofinity Commercial |
$1,432.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,432.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,841.81
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,739.48
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$1,289.26
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,514.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$1,514.37
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$715.95 |
| Rate for Payer: Aetna Commercial |
$676.17
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cofinity Commercial |
$684.13
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$715.95
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.17
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$501.17
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$588.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$588.67
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.17 |
| Max. Negotiated Rate |
$715.95 |
| Rate for Payer: Aetna Commercial |
$676.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.08
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Cofinity Commercial |
$684.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.40
|
| Rate for Payer: Healthscope Commercial |
$715.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.17
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health SBD |
$501.17
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$16,782.27
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,572.83 |
| Max. Negotiated Rate |
$15,104.04 |
| Rate for Payer: Aetna Commercial |
$14,264.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,908.48
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cofinity Commercial |
$11,747.59
|
| Rate for Payer: Cofinity Commercial |
$14,432.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,747.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,425.82
|
| Rate for Payer: Healthscope Commercial |
$15,104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,264.93
|
| Rate for Payer: PHP Commercial |
$14,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.48
|
| Rate for Payer: Priority Health SBD |
$10,572.83
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$16,782.27
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$14,264.93
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,908.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cofinity Commercial |
$14,432.75
|
| Rate for Payer: Cofinity Commercial |
$11,747.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,747.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,425.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$15,104.04
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,264.93
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$14,264.93
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.48
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$10,572.83
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,386.35
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,583.40 |
| Max. Negotiated Rate |
$16,547.72 |
| Rate for Payer: Aetna Commercial |
$15,628.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,951.13
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cofinity Commercial |
$12,870.44
|
| Rate for Payer: Cofinity Commercial |
$15,812.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,870.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,709.08
|
| Rate for Payer: Healthscope Commercial |
$16,547.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,628.40
|
| Rate for Payer: PHP Commercial |
$15,628.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,951.13
|
| Rate for Payer: Priority Health SBD |
$11,583.40
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,386.35
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$15,628.40
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,951.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cofinity Commercial |
$15,812.26
|
| Rate for Payer: Cofinity Commercial |
$12,870.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,870.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,709.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$16,547.72
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,628.40
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$15,628.40
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,951.13
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$11,583.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,628.69
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,806.07 |
| Max. Negotiated Rate |
$6,865.82 |
| Rate for Payer: Aetna Commercial |
$6,484.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,958.65
|
| Rate for Payer: Cash Price |
$6,102.95
|
| Rate for Payer: Cofinity Commercial |
$5,340.08
|
| Rate for Payer: Cofinity Commercial |
$6,560.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,340.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,102.95
|
| Rate for Payer: Healthscope Commercial |
$6,865.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,484.39
|
| Rate for Payer: PHP Commercial |
$6,484.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.65
|
| Rate for Payer: Priority Health SBD |
$4,806.07
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,628.69
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,051.48 |
| Max. Negotiated Rate |
$6,865.82 |
| Rate for Payer: Aetna Commercial |
$6,484.39
|
| Rate for Payer: Aetna Medicare |
$3,814.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,958.65
|
| Rate for Payer: BCBS Complete |
$3,051.48
|
| Rate for Payer: Cash Price |
$6,102.95
|
| Rate for Payer: Cofinity Commercial |
$5,340.08
|
| Rate for Payer: Cofinity Commercial |
$6,560.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,340.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,102.95
|
| Rate for Payer: Healthscope Commercial |
$6,865.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,484.39
|
| Rate for Payer: PHP Commercial |
$6,484.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.65
|
| Rate for Payer: Priority Health SBD |
$4,806.07
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
OP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.70 |
| 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 Commercial |
$1,311.97
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,311.97
|
| 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: PHP Commercial |
$1,593.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.26
|
| Rate for Payer: Priority Health SBD |
$1,180.78
|
|
|
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 Commercial |
$1,311.97
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,311.97
|
| 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: PHP Commercial |
$1,593.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.26
|
| Rate for Payer: Priority Health SBD |
$1,180.78
|
|
