|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,470.22 |
| 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 |
$8,300.25
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| 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 |
$7,470.22
|
|
|
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 |
$7,470.22
|
|
|
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 |
$2,828.00
|
| 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 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 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 |
$55.85 |
| Max. Negotiated Rate |
$1,841.80 |
| Rate for Payer: Aetna Commercial |
$1,739.48
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.37
|
| Rate for Payer: BCN Commercial |
$1,525.37
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,841.80
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$1,739.48
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$1,289.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$1,514.37
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
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 |
$1,841.80 |
| 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 |
$1,841.80
|
| 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 OUT BUBBLE STUDY
|
Facility
|
IP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.16 |
| Max. Negotiated Rate |
$715.95 |
| Rate for Payer: Aetna Commercial |
$676.18
|
| 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 |
$676.18
|
| Rate for Payer: PHP Commercial |
$676.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health SBD |
$501.16
|
|
|
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 |
$55.85 |
| Max. Negotiated Rate |
$1,193.12 |
| Rate for Payer: Aetna Commercial |
$676.18
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.12
|
| Rate for Payer: BCN Commercial |
$1,193.12
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$715.95
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.18
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$676.18
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$501.16
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$588.67
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
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 |
$687.26 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Commercial |
$14,264.93
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,908.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$5,227.56
|
| Rate for Payer: BCN Commercial |
$5,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cash Price |
$13,425.82
|
| 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: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$15,104.04
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,264.93
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$14,264.93
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$10,572.83
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.26
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
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 |
$500.08 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna Commercial |
$15,628.40
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,951.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,429.41
|
| Rate for Payer: BCN Commercial |
$7,429.41
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cash Price |
$14,709.08
|
| 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: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$16,547.72
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,628.40
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$15,628.40
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,951.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$11,583.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.08
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,905.22
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
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 |
$1,264.76 |
| Max. Negotiated Rate |
$9,445.00 |
| 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: BCBS Trust/PPO |
$2,424.09
|
| Rate for Payer: BCN Commercial |
$2,424.09
|
| Rate for Payer: Cash Price |
$6,102.95
|
| Rate for Payer: Cash Price |
$6,102.95
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,264.76
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
|
|
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 |
$1,686.82 |
| 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 |
$1,311.98
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,311.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,686.82
|
| 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
|
OP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,686.82 |
| 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 |
$1,311.98
|
| Rate for Payer: Cofinity Commercial |
$1,611.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,311.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,686.82
|
| 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 LVL 1
|
Facility
|
IP
|
$160.65
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.21 |
| Max. Negotiated Rate |
$144.58 |
| 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 |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.58
|
| 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 |
$144.58 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna Medicare |
$80.32
|
| 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 |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.58
|
| 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 |
$433.76 |
| Rate for Payer: Aetna Commercial |
$409.66
|
| Rate for Payer: Aetna Medicare |
$240.98
|
| 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 |
$337.36
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.56
|
| Rate for Payer: Healthscope Commercial |
$433.76
|
| 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 |
$433.76 |
| 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 |
$337.36
|
| Rate for Payer: Cofinity Commercial |
$414.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.56
|
| Rate for Payer: Healthscope Commercial |
$433.76
|
| 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 |
$1,183.46
|
| 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 |
$582.78 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Commercial |
$14,671.61
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,219.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$7,033.97
|
| Rate for Payer: BCN Commercial |
$7,033.97
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$13,808.58
|
| Rate for Payer: Cash Price |
$13,808.58
|
| 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: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$15,534.65
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,671.61
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$14,671.61
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,219.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$10,874.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.78
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
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 |
$975.83 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Commercial |
$4,466.17
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,415.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$5,227.56
|
| Rate for Payer: BCN Commercial |
$5,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$4,203.46
|
| 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 |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$4,728.89
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,466.17
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$4,466.17
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,415.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$3,310.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.83
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
