|
HC IRRIGATION OF BLADDER
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$177.16
|
| Rate for Payer: BCN Commercial |
$177.16
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$232.07
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.44
|
| Rate for Payer: UHC Core |
$191.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$144.77
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Core |
$9.60
|
| Rate for Payer: UHC Exchange |
$7.24
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
OP
|
$1,998.93
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.33 |
| Max. Negotiated Rate |
$1,799.04 |
| Rate for Payer: Aetna Commercial |
$1,699.09
|
| Rate for Payer: Aetna Medicare |
$999.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.30
|
| Rate for Payer: BCBS Complete |
$799.57
|
| Rate for Payer: BCBS Trust/PPO |
$114.33
|
| Rate for Payer: BCN Commercial |
$114.33
|
| Rate for Payer: Cash Price |
$1,599.14
|
| Rate for Payer: Cash Price |
$1,599.14
|
| Rate for Payer: Cofinity Advantage |
$1,399.25
|
| Rate for Payer: Cofinity Commercial |
$1,719.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.14
|
| Rate for Payer: Healthscope Commercial |
$1,799.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.20
|
| Rate for Payer: PHP Commercial |
$1,699.09
|
| Rate for Payer: Priority Health SBD |
$1,259.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.30
|
| Rate for Payer: UHC Core |
$1,041.44
|
| Rate for Payer: UHC Exchange |
$785.58
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
IP
|
$1,998.93
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,259.33 |
| Max. Negotiated Rate |
$1,799.04 |
| Rate for Payer: Aetna Commercial |
$1,699.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.30
|
| Rate for Payer: Cash Price |
$1,599.14
|
| Rate for Payer: Cofinity Advantage |
$1,399.25
|
| Rate for Payer: Cofinity Commercial |
$1,719.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.14
|
| Rate for Payer: Healthscope Commercial |
$1,799.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.20
|
| Rate for Payer: PHP Commercial |
$1,699.09
|
| Rate for Payer: Priority Health SBD |
$1,259.33
|
|
|
HC IR SHEATH
|
Facility
|
IP
|
$238.77
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$214.89 |
| Rate for Payer: PHP Commercial |
$202.95
|
| Rate for Payer: Aetna Commercial |
$202.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.20
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Advantage |
$167.14
|
| Rate for Payer: Cofinity Commercial |
$205.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$214.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: Priority Health SBD |
$150.43
|
|
|
HC IR SHEATH
|
Facility
|
OP
|
$238.77
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$214.89 |
| Rate for Payer: Aetna Commercial |
$202.95
|
| Rate for Payer: Aetna Medicare |
$119.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.20
|
| Rate for Payer: BCBS Complete |
$95.51
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Advantage |
$167.14
|
| Rate for Payer: Cofinity Commercial |
$205.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$214.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: PHP Commercial |
$202.95
|
| Rate for Payer: Priority Health SBD |
$150.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.20
|
| Rate for Payer: UHC Core |
$124.40
|
| Rate for Payer: UHC Exchange |
$93.84
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
IP
|
$743.65
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$669.28 |
| Rate for Payer: Aetna Commercial |
$632.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.37
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cofinity Advantage |
$520.55
|
| Rate for Payer: Cofinity Commercial |
$639.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.92
|
| Rate for Payer: Healthscope Commercial |
$669.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.74
|
| Rate for Payer: PHP Commercial |
$632.10
|
| Rate for Payer: Priority Health SBD |
$468.50
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
OP
|
$743.65
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$669.28 |
| Rate for Payer: Aetna Commercial |
$632.10
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$132.51
|
| Rate for Payer: BCN Commercial |
$132.51
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cofinity Advantage |
$520.55
|
| Rate for Payer: Cofinity Commercial |
$639.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$669.28
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.10
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.74
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$632.10
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$468.50
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.37
|
| Rate for Payer: UHC Core |
$387.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$292.25
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC IR SIALOGRAM
|
Facility
|
OP
|
$594.95
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$505.71
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.72
|
| 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 |
$215.78
|
| Rate for Payer: BCN Commercial |
$215.78
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Advantage |
$416.46
|
| Rate for Payer: Cofinity Commercial |
$511.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$535.46
|
| 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 |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$505.71
|
| 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 |
$374.82
|
| 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) |
$386.72
|
| Rate for Payer: UHC Core |
$309.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$233.82
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC IR SIALOGRAM
|
Facility
|
IP
|
$594.95
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.82 |
| Max. Negotiated Rate |
$535.46 |
| Rate for Payer: Aetna Commercial |
$505.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.72
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Advantage |
$416.46
|
| Rate for Payer: Cofinity Commercial |
$511.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$535.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: PHP Commercial |
$505.71
|
| Rate for Payer: Priority Health SBD |
$374.82
|
|
|
HC IR SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$1,492.33
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,268.48
|
| Rate for Payer: Aetna Commercial |
$845.66
|
| 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: BCBS Trust/PPO |
$395.15
|
| Rate for Payer: BCBS Trust/PPO |
$395.15
|
| Rate for Payer: BCN Commercial |
$395.15
|
| Rate for Payer: BCN Commercial |
$395.15
|
| 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 |
$1,193.86
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cofinity Advantage |
$1,044.63
|
| Rate for Payer: Cofinity Advantage |
$696.42
|
| Rate for Payer: Cofinity Commercial |
$1,283.40
|
| Rate for Payer: Cofinity Commercial |
$855.61
|
| 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 |
$1,268.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| 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 |
$746.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| 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 |
$1,268.48
|
| Rate for Payer: PHP Commercial |
$845.66
|
| 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 |
$940.17
|
| Rate for Payer: Priority Health SBD |
$626.78
|
| 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 Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| 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 SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$1,492.33
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$940.17 |
| Max. Negotiated Rate |
$1,343.10 |
| Rate for Payer: Aetna Commercial |
$1,268.48
|
| Rate for Payer: Aetna Commercial |
$845.66
|
| 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 |
$1,193.86
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cofinity Advantage |
$1,044.63
|
| Rate for Payer: Cofinity Advantage |
$696.42
|
| Rate for Payer: Cofinity Commercial |
$1,283.40
|
| Rate for Payer: Cofinity Commercial |
$855.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.86
|
| Rate for Payer: Healthscope Commercial |
$895.40
|
| Rate for Payer: Healthscope Commercial |
$1,343.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.17
|
| 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 SINAGRAM FISTULAGRAM
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.63
|
| 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 |
$80.26
|
| Rate for Payer: BCN Commercial |
$80.26
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Advantage |
$291.45
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| 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 |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$353.91
|
| 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 |
$262.31
|
| 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) |
$270.63
|
| Rate for Payer: UHC Core |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$163.63
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.63
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Advantage |
$291.45
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: Priority Health SBD |
$262.31
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
IP
|
$1,599.40
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,007.62 |
| Max. Negotiated Rate |
$1,439.46 |
| Rate for Payer: Aetna Commercial |
$1,359.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.61
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cofinity Advantage |
$1,119.58
|
| Rate for Payer: Cofinity Commercial |
$1,375.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,279.52
|
| Rate for Payer: Healthscope Commercial |
$1,439.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,359.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.55
|
| Rate for Payer: PHP Commercial |
$1,359.49
|
| Rate for Payer: Priority Health SBD |
$1,007.62
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
OP
|
$1,599.40
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$628.56 |
| Max. Negotiated Rate |
$2,654.47 |
| Rate for Payer: Aetna Commercial |
$1,359.49
|
| Rate for Payer: Aetna Medicare |
$799.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.61
|
| Rate for Payer: BCBS Complete |
$639.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,654.47
|
| Rate for Payer: BCN Commercial |
$2,654.47
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cofinity Advantage |
$1,119.58
|
| Rate for Payer: Cofinity Commercial |
$1,375.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,279.52
|
| Rate for Payer: Healthscope Commercial |
$1,439.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,279.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,359.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.55
|
| Rate for Payer: PHP Commercial |
$1,359.49
|
| Rate for Payer: Priority Health SBD |
$1,007.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.61
|
| Rate for Payer: UHC Core |
$833.29
|
| Rate for Payer: UHC Exchange |
$628.56
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
IP
|
$3,877.70
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,442.95 |
| Max. Negotiated Rate |
$3,489.93 |
| Rate for Payer: Aetna Commercial |
$3,296.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,520.51
|
| Rate for Payer: Cash Price |
$3,102.16
|
| Rate for Payer: Cofinity Advantage |
$2,714.39
|
| Rate for Payer: Cofinity Commercial |
$3,334.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.16
|
| Rate for Payer: Healthscope Commercial |
$3,489.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,908.28
|
| Rate for Payer: PHP Commercial |
$3,296.05
|
| Rate for Payer: Priority Health SBD |
$2,442.95
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
OP
|
$3,877.70
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.24 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$3,296.05
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,520.51
|
| 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 |
$317.24
|
| Rate for Payer: BCN Commercial |
$317.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,102.16
|
| Rate for Payer: Cash Price |
$3,102.16
|
| Rate for Payer: Cofinity Advantage |
$2,714.39
|
| Rate for Payer: Cofinity Commercial |
$3,334.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,489.93
|
| 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 |
$3,296.05
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,908.28
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$3,296.05
|
| 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 Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$2,442.95
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,520.51
|
| Rate for Payer: UHC Core |
$2,020.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$1,523.94
|
| 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 SUPERIOR VENACAVAGRAM
|
Facility
|
OP
|
$2,707.29
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.88 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Commercial |
$2,301.20
|
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,759.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$146.88
|
| Rate for Payer: BCN Commercial |
$146.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$2,165.83
|
| Rate for Payer: Cash Price |
$2,165.83
|
| Rate for Payer: Cofinity Advantage |
$1,895.10
|
| Rate for Payer: Cofinity Commercial |
$2,328.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,165.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$2,436.56
|
| Rate for Payer: Mclaren Medicaid |
$820.32
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,301.20
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,030.47
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$2,301.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health SBD |
$1,705.59
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,759.74
|
| Rate for Payer: UHC Core |
$1,410.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Exchange |
$1,063.96
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
IP
|
$2,707.29
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,705.59 |
| Max. Negotiated Rate |
$2,436.56 |
| Rate for Payer: Aetna Commercial |
$2,301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,759.74
|
| Rate for Payer: Cash Price |
$2,165.83
|
| Rate for Payer: Cofinity Advantage |
$1,895.10
|
| Rate for Payer: Cofinity Commercial |
$2,328.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,165.83
|
| Rate for Payer: Healthscope Commercial |
$2,436.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,301.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,030.47
|
| Rate for Payer: PHP Commercial |
$2,301.20
|
| Rate for Payer: Priority Health SBD |
$1,705.59
|
|
|
HC IR THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$8,632.22
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,376.58 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$7,337.39
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,610.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,376.58
|
| Rate for Payer: BCN Commercial |
$3,376.58
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$6,905.78
|
| Rate for Payer: Cash Price |
$6,905.78
|
| Rate for Payer: Cash Price |
$6,905.78
|
| Rate for Payer: Cofinity Advantage |
$6,042.55
|
| Rate for Payer: Cofinity Commercial |
$7,423.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,905.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$7,769.00
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,337.39
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,474.16
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$7,337.39
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$5,438.30
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC IR THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$8,632.22
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,438.30 |
| Max. Negotiated Rate |
$7,769.00 |
| Rate for Payer: Aetna Commercial |
$7,337.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,610.94
|
| Rate for Payer: Cash Price |
$6,905.78
|
| Rate for Payer: Cofinity Advantage |
$6,042.55
|
| Rate for Payer: Cofinity Commercial |
$7,423.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,905.78
|
| Rate for Payer: Healthscope Commercial |
$7,769.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,337.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,474.16
|
| Rate for Payer: PHP Commercial |
$7,337.39
|
| Rate for Payer: Priority Health SBD |
$5,438.30
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$2,451.87
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$980.75 |
| Max. Negotiated Rate |
$3,517.34 |
| Rate for Payer: Aetna Commercial |
$2,084.09
|
| Rate for Payer: Aetna Medicare |
$1,225.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,593.72
|
| Rate for Payer: BCBS Complete |
$980.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,517.34
|
| Rate for Payer: BCN Commercial |
$3,517.34
|
| Rate for Payer: Cash Price |
$1,961.50
|
| Rate for Payer: Cash Price |
$1,961.50
|
| Rate for Payer: Cofinity Advantage |
$1,716.31
|
| Rate for Payer: Cofinity Commercial |
$2,108.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,961.50
|
| Rate for Payer: Healthscope Commercial |
$2,206.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,961.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,084.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,838.90
|
| Rate for Payer: PHP Commercial |
$2,084.09
|
| Rate for Payer: Priority Health SBD |
$1,544.68
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$2,451.87
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,544.68 |
| Max. Negotiated Rate |
$2,206.68 |
| Rate for Payer: Aetna Commercial |
$2,084.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,593.72
|
| Rate for Payer: Cash Price |
$1,961.50
|
| Rate for Payer: Cofinity Advantage |
$1,716.31
|
| Rate for Payer: Cofinity Commercial |
$2,108.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,961.50
|
| Rate for Payer: Healthscope Commercial |
$2,206.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,084.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,838.90
|
| Rate for Payer: PHP Commercial |
$2,084.09
|
| Rate for Payer: Priority Health SBD |
$1,544.68
|
|
