|
HC IR EMBOLIZATION
|
Facility
|
IP
|
$3,569.52
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,248.80 |
| Max. Negotiated Rate |
$3,212.57 |
| Rate for Payer: Aetna Commercial |
$3,034.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,320.19
|
| Rate for Payer: Cash Price |
$2,855.62
|
| Rate for Payer: Cofinity Advantage |
$2,498.66
|
| Rate for Payer: Cofinity Commercial |
$3,069.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,855.62
|
| Rate for Payer: Healthscope Commercial |
$3,212.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,677.14
|
| Rate for Payer: PHP Commercial |
$3,034.09
|
| Rate for Payer: Priority Health SBD |
$2,248.80
|
|
|
HC IR ERCP
|
Facility
|
OP
|
$832.99
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.29 |
| Max. Negotiated Rate |
$749.69 |
| Rate for Payer: Aetna Commercial |
$708.04
|
| Rate for Payer: Aetna Medicare |
$416.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.44
|
| Rate for Payer: BCBS Complete |
$333.20
|
| Rate for Payer: BCBS Trust/PPO |
$164.29
|
| Rate for Payer: BCN Commercial |
$164.29
|
| Rate for Payer: Cash Price |
$666.39
|
| Rate for Payer: Cash Price |
$666.39
|
| Rate for Payer: Cofinity Advantage |
$583.09
|
| Rate for Payer: Cofinity Commercial |
$716.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.39
|
| Rate for Payer: Healthscope Commercial |
$749.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$666.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.74
|
| Rate for Payer: PHP Commercial |
$708.04
|
| Rate for Payer: Priority Health SBD |
$524.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.44
|
| Rate for Payer: UHC Core |
$433.99
|
| Rate for Payer: UHC Exchange |
$327.37
|
|
|
HC IR ERCP
|
Facility
|
IP
|
$832.99
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$524.78 |
| Max. Negotiated Rate |
$749.69 |
| Rate for Payer: Aetna Commercial |
$708.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.44
|
| Rate for Payer: Cash Price |
$666.39
|
| Rate for Payer: Cofinity Advantage |
$583.09
|
| Rate for Payer: Cofinity Commercial |
$716.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.39
|
| Rate for Payer: Healthscope Commercial |
$749.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.74
|
| Rate for Payer: PHP Commercial |
$708.04
|
| Rate for Payer: Priority Health SBD |
$524.78
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
OP
|
$641.52
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.12 |
| Max. Negotiated Rate |
$577.37 |
| Rate for Payer: Aetna Commercial |
$545.29
|
| Rate for Payer: Aetna Medicare |
$320.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.99
|
| Rate for Payer: BCBS Complete |
$256.61
|
| Rate for Payer: BCBS Trust/PPO |
$454.29
|
| Rate for Payer: BCN Commercial |
$454.29
|
| Rate for Payer: Cash Price |
$513.22
|
| Rate for Payer: Cash Price |
$513.22
|
| Rate for Payer: Cofinity Advantage |
$449.06
|
| Rate for Payer: Cofinity Commercial |
$551.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.22
|
| Rate for Payer: Healthscope Commercial |
$577.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$513.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.14
|
| Rate for Payer: PHP Commercial |
$545.29
|
| Rate for Payer: Priority Health SBD |
$404.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.99
|
| Rate for Payer: UHC Core |
$334.23
|
| Rate for Payer: UHC Exchange |
$252.12
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
IP
|
$641.52
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.16 |
| Max. Negotiated Rate |
$577.37 |
| Rate for Payer: Aetna Commercial |
$545.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.99
|
| Rate for Payer: Cash Price |
$513.22
|
| Rate for Payer: Cofinity Advantage |
$449.06
|
| Rate for Payer: Cofinity Commercial |
$551.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.22
|
| Rate for Payer: Healthscope Commercial |
$577.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.14
|
| Rate for Payer: PHP Commercial |
$545.29
|
| Rate for Payer: Priority Health SBD |
$404.16
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.84 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$179.45
|
| Rate for Payer: BCN Commercial |
$179.45
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Advantage |
$218.79
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.16
|
| Rate for Payer: UHC Core |
$162.84
|
| Rate for Payer: UHC Exchange |
$122.84
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Advantage |
$218.79
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: Priority Health SBD |
$196.91
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
IP
|
$572.82
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.88 |
| Max. Negotiated Rate |
$515.54 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.33
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cofinity Advantage |
$400.97
|
| Rate for Payer: Cofinity Commercial |
$492.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.26
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.62
|
| Rate for Payer: PHP Commercial |
$486.90
|
| Rate for Payer: Priority Health SBD |
$360.88
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
OP
|
$572.82
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$515.54 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Medicare |
$286.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.33
|
| Rate for Payer: BCBS Complete |
$229.13
|
| Rate for Payer: BCBS Trust/PPO |
$169.60
|
| Rate for Payer: BCN Commercial |
$169.60
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cofinity Advantage |
$400.97
|
| Rate for Payer: Cofinity Commercial |
$492.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.26
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.62
|
| Rate for Payer: PHP Commercial |
$486.90
|
| Rate for Payer: Priority Health SBD |
$360.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.33
|
| Rate for Payer: UHC Core |
$298.44
|
| Rate for Payer: UHC Exchange |
$225.12
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
OP
|
$572.82
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$63.60
|
| Rate for Payer: BCN Commercial |
$63.60
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cofinity Advantage |
$400.97
|
| Rate for Payer: Cofinity Commercial |
$492.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.90
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.62
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$486.90
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$360.88
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.33
|
| Rate for Payer: UHC Core |
$298.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$225.12
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
IP
|
$572.82
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.88 |
| Max. Negotiated Rate |
$515.54 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.33
|
| Rate for Payer: Cash Price |
$458.26
|
| Rate for Payer: Cofinity Advantage |
$400.97
|
| Rate for Payer: Cofinity Commercial |
$492.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.26
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.62
|
| Rate for Payer: PHP Commercial |
$486.90
|
| Rate for Payer: Priority Health SBD |
$360.88
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$994.89
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.78 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Aetna Commercial |
$845.66
|
| Rate for Payer: Aetna Commercial |
$1,268.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.68
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cofinity Advantage |
$696.42
|
| Rate for Payer: Cofinity Advantage |
$1,044.63
|
| Rate for Payer: Cofinity Commercial |
$855.61
|
| Rate for Payer: Cofinity Commercial |
$1,283.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.91
|
| Rate for Payer: Healthscope Commercial |
$1,343.10
|
| Rate for Payer: Healthscope Commercial |
$895.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| Rate for Payer: PHP Commercial |
$1,268.48
|
| Rate for Payer: PHP Commercial |
$845.66
|
| Rate for Payer: Priority Health SBD |
$940.17
|
| Rate for Payer: Priority Health SBD |
$626.78
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$994.89
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$845.66
|
| Rate for Payer: Aetna Commercial |
$1,268.48
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cofinity Advantage |
$696.42
|
| Rate for Payer: Cofinity Advantage |
$1,044.63
|
| Rate for Payer: Cofinity Commercial |
$855.61
|
| Rate for Payer: Cofinity Commercial |
$1,283.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,343.10
|
| Rate for Payer: Healthscope Commercial |
$895.40
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.48
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$845.66
|
| Rate for Payer: PHP Commercial |
$1,268.48
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$626.78
|
| Rate for Payer: Priority Health SBD |
$940.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.01
|
| Rate for Payer: UHC Core |
$518.34
|
| Rate for Payer: UHC Core |
$777.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$390.99
|
| Rate for Payer: UHC Exchange |
$586.49
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
IP
|
$1,537.04
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$968.34 |
| Max. Negotiated Rate |
$1,383.34 |
| Rate for Payer: Aetna Commercial |
$1,306.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.08
|
| Rate for Payer: Cash Price |
$1,229.63
|
| Rate for Payer: Cofinity Advantage |
$1,075.93
|
| Rate for Payer: Cofinity Commercial |
$1,321.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.63
|
| Rate for Payer: Healthscope Commercial |
$1,383.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.78
|
| Rate for Payer: PHP Commercial |
$1,306.48
|
| Rate for Payer: Priority Health SBD |
$968.34
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
OP
|
$1,537.04
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$486.09 |
| Max. Negotiated Rate |
$1,383.34 |
| Rate for Payer: Aetna Commercial |
$1,306.48
|
| Rate for Payer: Aetna Medicare |
$768.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.08
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS Trust/PPO |
$486.09
|
| Rate for Payer: BCN Commercial |
$486.09
|
| Rate for Payer: Cash Price |
$1,229.63
|
| Rate for Payer: Cash Price |
$1,229.63
|
| Rate for Payer: Cofinity Advantage |
$1,075.93
|
| Rate for Payer: Cofinity Commercial |
$1,321.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.63
|
| Rate for Payer: Healthscope Commercial |
$1,383.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,229.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.78
|
| Rate for Payer: PHP Commercial |
$1,306.48
|
| Rate for Payer: Priority Health SBD |
$968.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.08
|
| Rate for Payer: UHC Core |
$800.80
|
| Rate for Payer: UHC Exchange |
$604.06
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
IP
|
$2,249.70
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,417.31 |
| Max. Negotiated Rate |
$2,024.73 |
| Rate for Payer: Aetna Commercial |
$1,912.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.31
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cofinity Advantage |
$1,574.79
|
| Rate for Payer: Cofinity Commercial |
$1,934.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.76
|
| Rate for Payer: Healthscope Commercial |
$2,024.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.28
|
| Rate for Payer: PHP Commercial |
$1,912.24
|
| Rate for Payer: Priority Health SBD |
$1,417.31
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
OP
|
$2,249.70
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,912.24
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$480.45
|
| Rate for Payer: BCN Commercial |
$480.45
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cofinity Advantage |
$1,574.79
|
| Rate for Payer: Cofinity Commercial |
$1,934.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$2,024.73
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.24
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.28
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,912.24
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$1,417.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.43 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna Medicare |
$173.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.65
|
| Rate for Payer: BCBS Complete |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$212.76
|
| Rate for Payer: BCN Commercial |
$212.76
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Advantage |
$243.00
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health SBD |
$218.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.65
|
| Rate for Payer: UHC Core |
$180.87
|
| Rate for Payer: UHC Exchange |
$136.43
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.65
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Advantage |
$243.00
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health SBD |
$218.70
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
OP
|
$266.57
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$239.91 |
| Rate for Payer: Aetna Commercial |
$226.58
|
| Rate for Payer: Aetna Medicare |
$133.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.27
|
| Rate for Payer: BCBS Complete |
$106.63
|
| Rate for Payer: BCBS Trust/PPO |
$65.88
|
| Rate for Payer: BCCCP Commercial |
$55.83
|
| Rate for Payer: BCN Commercial |
$65.88
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cofinity Advantage |
$186.60
|
| Rate for Payer: Cofinity Commercial |
$229.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.26
|
| Rate for Payer: Healthscope Commercial |
$239.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.93
|
| Rate for Payer: PHP Commercial |
$226.58
|
| Rate for Payer: Priority Health SBD |
$167.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.27
|
| Rate for Payer: UHC Core |
$138.88
|
| Rate for Payer: UHC Exchange |
$104.76
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
IP
|
$266.57
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$167.94 |
| Max. Negotiated Rate |
$239.91 |
| Rate for Payer: Aetna Commercial |
$226.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.27
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cofinity Advantage |
$186.60
|
| Rate for Payer: Cofinity Commercial |
$229.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.26
|
| Rate for Payer: Healthscope Commercial |
$239.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.93
|
| Rate for Payer: PHP Commercial |
$226.58
|
| Rate for Payer: Priority Health SBD |
$167.94
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.54 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$135.54
|
| Rate for Payer: BCN Commercial |
$135.54
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.71
|
| Rate for Payer: UHC Core |
$206.57
|
| Rate for Payer: UHC Exchange |
$155.82
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC IR GUIDEWIRE
|
Facility
|
IP
|
$45.63
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.66
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Advantage |
$31.94
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: Priority Health SBD |
$28.75
|
|
|
HC IR GUIDEWIRE
|
Facility
|
OP
|
$45.63
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$22.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.66
|
| Rate for Payer: BCBS Complete |
$18.25
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Advantage |
$31.94
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: Priority Health SBD |
$28.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.66
|
| Rate for Payer: UHC Core |
$23.77
|
| Rate for Payer: UHC Exchange |
$17.93
|
|
