|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.30 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.22
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Advantage |
$347.00
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: Priority Health SBD |
$312.30
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,124.16 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$248.34
|
| Rate for Payer: BCN Commercial |
$248.34
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Advantage |
$347.00
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$312.30
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.22
|
| Rate for Payer: UHC Core |
$258.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$194.82
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
OP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$715.87
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$779.46
|
| Rate for Payer: BCN Commercial |
$779.46
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Advantage |
$589.54
|
| Rate for Payer: Cofinity Commercial |
$724.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$757.98
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$715.87
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$530.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.43
|
| Rate for Payer: UHC Core |
$438.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$330.98
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
IP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$530.59 |
| Max. Negotiated Rate |
$757.98 |
| Rate for Payer: Aetna Commercial |
$715.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.43
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Advantage |
$589.54
|
| Rate for Payer: Cofinity Commercial |
$724.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Healthscope Commercial |
$757.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: PHP Commercial |
$715.87
|
| Rate for Payer: Priority Health SBD |
$530.59
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
OP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.45 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$1,697.59
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,298.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$179.45
|
| Rate for Payer: BCN Commercial |
$179.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Advantage |
$1,398.01
|
| Rate for Payer: Cofinity Commercial |
$1,717.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$1,797.44
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$1,697.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,258.21
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.15
|
| Rate for Payer: UHC Core |
$1,040.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$784.88
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
IP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,258.21 |
| Max. Negotiated Rate |
$1,797.44 |
| Rate for Payer: Aetna Commercial |
$1,697.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,298.15
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Advantage |
$1,398.01
|
| Rate for Payer: Cofinity Commercial |
$1,717.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Healthscope Commercial |
$1,797.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: PHP Commercial |
$1,697.59
|
| Rate for Payer: Priority Health SBD |
$1,258.21
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
OP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.29 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,731.47
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,853.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$164.29
|
| Rate for Payer: BCN Commercial |
$164.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Advantage |
$3,072.98
|
| Rate for Payer: Cofinity Commercial |
$3,775.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,950.97
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,731.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,853.48
|
| Rate for Payer: UHC Core |
$2,287.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,725.26
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
IP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,765.68 |
| Max. Negotiated Rate |
$3,950.97 |
| Rate for Payer: Aetna Commercial |
$3,731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,853.48
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Advantage |
$3,072.98
|
| Rate for Payer: Cofinity Commercial |
$3,775.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Healthscope Commercial |
$3,950.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: PHP Commercial |
$3,731.47
|
| Rate for Payer: Priority Health SBD |
$2,765.68
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
OP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.56 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,008.80
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,300.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$138.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Advantage |
$2,477.84
|
| Rate for Payer: Cofinity Commercial |
$3,044.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,185.79
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,008.80
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,230.06
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,300.85
|
| Rate for Payer: UHC Core |
$1,844.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,391.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
IP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,230.06 |
| Max. Negotiated Rate |
$3,185.79 |
| Rate for Payer: Aetna Commercial |
$3,008.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,300.85
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Advantage |
$2,477.84
|
| Rate for Payer: Cofinity Commercial |
$3,044.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Healthscope Commercial |
$3,185.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: PHP Commercial |
$3,008.80
|
| Rate for Payer: Priority Health SBD |
$2,230.06
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
IP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.84 |
| Max. Negotiated Rate |
$1,164.06 |
| Rate for Payer: Aetna Commercial |
$1,099.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.71
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Advantage |
$905.38
|
| Rate for Payer: Cofinity Commercial |
$1,112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Healthscope Commercial |
$1,164.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: PHP Commercial |
$1,099.39
|
| Rate for Payer: Priority Health SBD |
$814.84
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
OP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,099.39
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.70
|
| Rate for Payer: BCN Commercial |
$1,044.70
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Advantage |
$905.38
|
| Rate for Payer: Cofinity Commercial |
$1,112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,164.06
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,099.39
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$814.84
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
IP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,060.86 |
| Max. Negotiated Rate |
$1,515.52 |
| Rate for Payer: Aetna Commercial |
$1,431.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.54
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Advantage |
$1,178.74
|
| Rate for Payer: Cofinity Commercial |
$1,448.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Healthscope Commercial |
$1,515.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: PHP Commercial |
$1,431.32
|
| Rate for Payer: Priority Health SBD |
$1,060.86
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
OP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,431.32
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$752.05
|
| Rate for Payer: BCN Commercial |
$752.05
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Advantage |
$1,178.74
|
| Rate for Payer: Cofinity Commercial |
$1,448.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,515.52
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,431.32
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$1,060.86
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
IP
|
$4,942.81
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,113.97 |
| Max. Negotiated Rate |
$4,448.53 |
| Rate for Payer: Aetna Commercial |
$4,201.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,212.83
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cofinity Advantage |
$3,459.97
|
| Rate for Payer: Cofinity Commercial |
$4,250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.25
|
| Rate for Payer: Healthscope Commercial |
$4,448.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.11
|
| Rate for Payer: PHP Commercial |
$4,201.39
|
| Rate for Payer: Priority Health SBD |
$3,113.97
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
OP
|
$4,942.81
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,456.78 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Commercial |
$4,201.39
|
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,212.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.78
|
| Rate for Payer: BCN Commercial |
$1,456.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cofinity Advantage |
$3,459.97
|
| Rate for Payer: Cofinity Commercial |
$4,250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$4,448.53
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.39
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.11
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$4,201.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health SBD |
$3,113.97
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
IP
|
$5,103.92
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,215.47 |
| Max. Negotiated Rate |
$4,593.53 |
| Rate for Payer: Aetna Commercial |
$4,338.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,317.55
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cofinity Advantage |
$3,572.74
|
| Rate for Payer: Cofinity Commercial |
$4,389.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.14
|
| Rate for Payer: Healthscope Commercial |
$4,593.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,338.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,827.94
|
| Rate for Payer: PHP Commercial |
$4,338.33
|
| Rate for Payer: Priority Health SBD |
$3,215.47
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
OP
|
$5,103.92
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$4,338.33
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,317.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.50
|
| Rate for Payer: BCN Commercial |
$1,882.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cofinity Advantage |
$3,572.74
|
| Rate for Payer: Cofinity Commercial |
$4,389.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,593.53
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,338.33
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,827.94
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$4,338.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$3,215.47
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,665.30
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,939.14 |
| Max. Negotiated Rate |
$4,198.77 |
| Rate for Payer: Aetna Commercial |
$3,965.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,032.45
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cofinity Advantage |
$3,265.71
|
| Rate for Payer: Cofinity Commercial |
$4,012.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,732.24
|
| Rate for Payer: Healthscope Commercial |
$4,198.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,965.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,498.97
|
| Rate for Payer: PHP Commercial |
$3,965.51
|
| Rate for Payer: Priority Health SBD |
$2,939.14
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,665.30
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,460.54 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,965.51
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,032.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,460.54
|
| Rate for Payer: BCN Commercial |
$1,460.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cofinity Advantage |
$3,265.71
|
| Rate for Payer: Cofinity Commercial |
$4,012.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,732.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,198.77
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,965.51
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,498.97
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,965.51
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,939.14
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR INSERT TUNNEL PERI CATH W PORT
|
Facility
|
IP
|
$4,963.24
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
36100366
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,126.84 |
| Max. Negotiated Rate |
$4,466.92 |
| Rate for Payer: Aetna Commercial |
$4,218.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,226.11
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cofinity Advantage |
$3,474.27
|
| Rate for Payer: Cofinity Commercial |
$4,268.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,970.59
|
| Rate for Payer: Healthscope Commercial |
$4,466.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,218.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,722.43
|
| Rate for Payer: PHP Commercial |
$4,218.75
|
| Rate for Payer: Priority Health SBD |
$3,126.84
|
|
|
HC IR INSERT TUNNEL PERI CATH W PORT
|
Facility
|
OP
|
$4,963.24
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
36100366
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,671.66 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Aetna Commercial |
$4,218.75
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,226.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.66
|
| Rate for Payer: BCN Commercial |
$1,671.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cofinity Advantage |
$3,474.27
|
| Rate for Payer: Cofinity Commercial |
$4,268.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,970.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$4,466.92
|
| Rate for Payer: Mclaren Medicaid |
$2,899.76
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,218.75
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,722.43
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$4,218.75
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health SBD |
$3,126.84
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC IR INTERNAL MAMM ARTERIOGRAM
|
Facility
|
OP
|
$2,015.23
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
32000198
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.31 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$245.31
|
| Rate for Payer: BCN Commercial |
$245.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.90
|
| Rate for Payer: UHC Core |
$1,049.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$791.99
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR INTERNAL MAMM ARTERIOGRAM
|
Facility
|
IP
|
$2,015.23
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
32000198
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,269.59 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
|
|
HC IR INTERNAL MAMM ARTERIOGRAM BILAT
|
Facility
|
OP
|
$2,639.16
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
32000199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.31 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$2,243.29
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$245.31
|
| Rate for Payer: BCN Commercial |
$245.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,111.33
|
| Rate for Payer: Cash Price |
$2,111.33
|
| Rate for Payer: Cofinity Advantage |
$1,847.41
|
| Rate for Payer: Cofinity Commercial |
$2,269.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,111.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$2,375.24
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,243.29
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,979.37
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$2,243.29
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$1,662.67
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,715.45
|
| Rate for Payer: UHC Core |
$1,375.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,037.19
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
