|
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 Commercial |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.45
|
| 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: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health SBD |
$101.21
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
OP
|
$160.65
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.26 |
| 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 Commercial |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.45
|
| 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: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health SBD |
$101.21
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
OP
|
$481.95
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.78 |
| 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 Commercial |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.37
|
| 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: PHP Commercial |
$409.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.27
|
| Rate for Payer: Priority Health SBD |
$303.63
|
|
|
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 Commercial |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.37
|
| 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: PHP Commercial |
$409.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.27
|
| Rate for Payer: Priority Health SBD |
$303.63
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
OP
|
$2,366.91
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.76 |
| 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 Commercial |
$1,656.84
|
| Rate for Payer: Cofinity Commercial |
$2,035.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.84
|
| 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: PHP Commercial |
$2,011.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.49
|
| Rate for Payer: Priority Health SBD |
$1,491.15
|
|
|
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 Commercial |
$1,656.84
|
| Rate for Payer: Cofinity Commercial |
$2,035.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.84
|
| 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: PHP Commercial |
$2,011.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.49
|
| Rate for Payer: Priority Health SBD |
$1,491.15
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
IP
|
$17,260.72
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,874.25 |
| Max. Negotiated Rate |
$15,534.65 |
| Rate for Payer: Aetna Commercial |
$14,671.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,219.47
|
| Rate for Payer: Cash Price |
$13,808.58
|
| Rate for Payer: Cofinity Commercial |
$12,082.50
|
| Rate for Payer: Cofinity Commercial |
$14,844.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,082.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,808.58
|
| Rate for Payer: Healthscope Commercial |
$15,534.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,671.61
|
| Rate for Payer: PHP Commercial |
$14,671.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,219.47
|
| Rate for Payer: Priority Health SBD |
$10,874.25
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
OP
|
$17,260.72
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$14,671.61
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,219.47
|
| 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 |
$13,808.58
|
| Rate for Payer: Cash Price |
$13,808.58
|
| Rate for Payer: Cofinity Commercial |
$14,844.22
|
| Rate for Payer: Cofinity Commercial |
$12,082.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,082.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,808.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$15,534.65
|
| 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 |
$14,671.61
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$14,671.61
|
| 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 |
$11,219.47
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$10,874.25
|
| 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 NON-CNS HEAD OR NECK
|
Facility
|
IP
|
$5,254.32
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,310.22 |
| Max. Negotiated Rate |
$4,728.89 |
| Rate for Payer: Aetna Commercial |
$4,466.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,415.31
|
| Rate for Payer: Cash Price |
$4,203.46
|
| Rate for Payer: Cofinity Commercial |
$3,678.02
|
| Rate for Payer: Cofinity Commercial |
$4,518.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,678.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,203.46
|
| Rate for Payer: Healthscope Commercial |
$4,728.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,466.17
|
| Rate for Payer: PHP Commercial |
$4,466.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,415.31
|
| Rate for Payer: Priority Health SBD |
$3,310.22
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
OP
|
$5,254.32
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,310.22 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$4,466.17
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,415.31
|
| 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 |
$4,203.46
|
| Rate for Payer: Cash Price |
$4,203.46
|
| Rate for Payer: Cofinity Commercial |
$3,678.02
|
| Rate for Payer: Cofinity Commercial |
$4,518.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,678.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,203.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$4,728.89
|
| 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 |
$4,466.17
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$4,466.17
|
| 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 |
$3,415.31
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$3,310.22
|
| 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 URETER
|
Facility
|
OP
|
$428.76
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$385.88 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: Aetna Medicare |
$214.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.69
|
| Rate for Payer: BCBS Complete |
$171.50
|
| Rate for Payer: Cash Price |
$343.01
|
| Rate for Payer: Cofinity Commercial |
$300.13
|
| Rate for Payer: Cofinity Commercial |
$368.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.01
|
| Rate for Payer: Healthscope Commercial |
$385.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.45
|
| Rate for Payer: PHP Commercial |
$364.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.69
|
| Rate for Payer: Priority Health SBD |
$270.12
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
IP
|
$428.76
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.12 |
| Max. Negotiated Rate |
$385.88 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.69
|
| Rate for Payer: Cash Price |
$343.01
|
| Rate for Payer: Cofinity Commercial |
$300.13
|
| Rate for Payer: Cofinity Commercial |
$368.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.01
|
| Rate for Payer: Healthscope Commercial |
$385.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.45
|
| Rate for Payer: PHP Commercial |
$364.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.69
|
| Rate for Payer: Priority Health SBD |
$270.12
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$21,556.74
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,580.75 |
| Max. Negotiated Rate |
$19,401.07 |
| Rate for Payer: Aetna Commercial |
$18,323.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,011.88
|
| Rate for Payer: Cash Price |
$17,245.39
|
| Rate for Payer: Cofinity Commercial |
$15,089.72
|
| Rate for Payer: Cofinity Commercial |
$18,538.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,089.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,245.39
|
| Rate for Payer: Healthscope Commercial |
$19,401.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,323.23
|
| Rate for Payer: PHP Commercial |
$18,323.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,011.88
|
| Rate for Payer: Priority Health SBD |
$13,580.75
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$21,556.74
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$18,323.23
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,011.88
|
| 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 |
$17,245.39
|
| Rate for Payer: Cash Price |
$17,245.39
|
| Rate for Payer: Cofinity Commercial |
$15,089.72
|
| Rate for Payer: Cofinity Commercial |
$18,538.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,089.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,245.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$19,401.07
|
| 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 |
$18,323.23
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$18,323.23
|
| 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 |
$14,011.88
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$13,580.75
|
| 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 EMBOSHIELD SYSTEM
|
Facility
|
OP
|
$5,902.41
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.96 |
| Max. Negotiated Rate |
$5,312.17 |
| Rate for Payer: Aetna Commercial |
$5,017.05
|
| Rate for Payer: Aetna Medicare |
$2,951.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,836.57
|
| Rate for Payer: BCBS Complete |
$2,360.96
|
| Rate for Payer: Cash Price |
$4,721.93
|
| Rate for Payer: Cofinity Commercial |
$4,131.69
|
| Rate for Payer: Cofinity Commercial |
$5,076.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,131.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,721.93
|
| Rate for Payer: Healthscope Commercial |
$5,312.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,017.05
|
| Rate for Payer: PHP Commercial |
$5,017.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,836.57
|
| Rate for Payer: Priority Health SBD |
$3,718.52
|
|
|
HC EMBOSHIELD SYSTEM
|
Facility
|
IP
|
$5,902.41
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,718.52 |
| Max. Negotiated Rate |
$5,312.17 |
| Rate for Payer: Aetna Commercial |
$5,017.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,836.57
|
| Rate for Payer: Cash Price |
$4,721.93
|
| Rate for Payer: Cofinity Commercial |
$4,131.69
|
| Rate for Payer: Cofinity Commercial |
$5,076.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,131.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,721.93
|
| Rate for Payer: Healthscope Commercial |
$5,312.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,017.05
|
| Rate for Payer: PHP Commercial |
$5,017.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,836.57
|
| Rate for Payer: Priority Health SBD |
$3,718.52
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$140.97
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$126.87 |
| Rate for Payer: Aetna Commercial |
$119.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.63
|
| Rate for Payer: Cash Price |
$112.78
|
| Rate for Payer: Cofinity Commercial |
$121.23
|
| Rate for Payer: Cofinity Commercial |
$98.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.78
|
| Rate for Payer: Healthscope Commercial |
$126.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.82
|
| Rate for Payer: PHP Commercial |
$119.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.63
|
| Rate for Payer: Priority Health SBD |
$88.81
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$140.97
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$119.82
|
| Rate for Payer: Aetna Medicare |
$70.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.63
|
| Rate for Payer: BCBS Complete |
$56.39
|
| Rate for Payer: Cash Price |
$112.78
|
| Rate for Payer: Cash Price |
$112.78
|
| Rate for Payer: Cofinity Commercial |
$121.23
|
| Rate for Payer: Cofinity Commercial |
$98.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.78
|
| Rate for Payer: Healthscope Commercial |
$126.87
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.82
|
| Rate for Payer: PHP Commercial |
$119.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.63
|
| Rate for Payer: Priority Health SBD |
$88.81
|
| Rate for Payer: UHC Core |
$104.32
|
| Rate for Payer: UHC Exchange |
$104.32
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
OP
|
$351.04
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$298.38
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$280.83
|
| Rate for Payer: Cash Price |
$280.83
|
| Rate for Payer: Cofinity Commercial |
$301.89
|
| Rate for Payer: Cofinity Commercial |
$245.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$315.94
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.38
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$298.38
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.18
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$221.16
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Core |
$259.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$259.77
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
IP
|
$351.04
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$315.94 |
| Rate for Payer: Aetna Commercial |
$298.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.18
|
| Rate for Payer: Cash Price |
$280.83
|
| Rate for Payer: Cofinity Commercial |
$245.73
|
| Rate for Payer: Cofinity Commercial |
$301.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.83
|
| Rate for Payer: Healthscope Commercial |
$315.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.38
|
| Rate for Payer: PHP Commercial |
$298.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.18
|
| Rate for Payer: Priority Health SBD |
$221.16
|
|
|
HC EMG BLADDER
|
Facility
|
IP
|
$365.12
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$230.03 |
| Max. Negotiated Rate |
$328.61 |
| Rate for Payer: Aetna Commercial |
$310.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.33
|
| Rate for Payer: Cash Price |
$292.10
|
| Rate for Payer: Cofinity Commercial |
$255.58
|
| Rate for Payer: Cofinity Commercial |
$314.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.10
|
| Rate for Payer: Healthscope Commercial |
$328.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.35
|
| Rate for Payer: PHP Commercial |
$310.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.33
|
| Rate for Payer: Priority Health SBD |
$230.03
|
|
|
HC EMG BLADDER
|
Facility
|
OP
|
$365.12
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$310.35
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$292.10
|
| Rate for Payer: Cash Price |
$292.10
|
| Rate for Payer: Cofinity Commercial |
$255.58
|
| Rate for Payer: Cofinity Commercial |
$314.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$328.61
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.35
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$310.35
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.33
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$230.03
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$270.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$270.19
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
IP
|
$246.37
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$221.73 |
| Rate for Payer: Aetna Commercial |
$209.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.14
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cofinity Commercial |
$172.46
|
| Rate for Payer: Cofinity Commercial |
$211.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$221.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.41
|
| Rate for Payer: PHP Commercial |
$209.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.14
|
| Rate for Payer: Priority Health SBD |
$155.21
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
OP
|
$246.37
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$221.73 |
| Rate for Payer: Aetna Commercial |
$209.41
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cofinity Commercial |
$211.88
|
| Rate for Payer: Cofinity Commercial |
$172.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$221.73
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.41
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$209.41
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.14
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$155.21
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$182.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$182.31
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
IP
|
$612.05
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$550.85 |
| Rate for Payer: Aetna Commercial |
$520.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.83
|
| Rate for Payer: Cash Price |
$489.64
|
| Rate for Payer: Cofinity Commercial |
$428.44
|
| Rate for Payer: Cofinity Commercial |
$526.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.64
|
| Rate for Payer: Healthscope Commercial |
$550.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.24
|
| Rate for Payer: PHP Commercial |
$520.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.83
|
| Rate for Payer: Priority Health SBD |
$385.59
|
|
