|
HC IR ATHERECTOMY STENT FEMPOP UNI
|
Facility
|
OP
|
$20,088.35
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
36100171
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$17,075.10
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,057.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cofinity Commercial |
$17,275.98
|
| Rate for Payer: Cofinity Commercial |
$14,061.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,061.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,070.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$18,079.51
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,075.10
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$17,075.10
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,057.43
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$12,655.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC IR ATHERECTOMY STENT FEMPOP UNI
|
Facility
|
IP
|
$20,088.35
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
36100171
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,655.66 |
| Max. Negotiated Rate |
$18,079.51 |
| Rate for Payer: Aetna Commercial |
$17,075.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,057.43
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cofinity Commercial |
$14,061.84
|
| Rate for Payer: Cofinity Commercial |
$17,275.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,061.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,070.68
|
| Rate for Payer: Healthscope Commercial |
$18,079.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,075.10
|
| Rate for Payer: PHP Commercial |
$17,075.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,057.43
|
| Rate for Payer: Priority Health SBD |
$12,655.66
|
|
|
HC IR ATHERECTOMY TIB PERONL UNI
|
Facility
|
OP
|
$21,959.58
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
36100173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$18,665.64
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,273.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$17,567.66
|
| Rate for Payer: Cash Price |
$17,567.66
|
| Rate for Payer: Cofinity Commercial |
$18,885.24
|
| Rate for Payer: Cofinity Commercial |
$15,371.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,371.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,567.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$19,763.62
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,665.64
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$18,665.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,273.73
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$13,834.54
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC IR ATHERECTOMY TIB PERONL UNI
|
Facility
|
IP
|
$21,959.58
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
36100173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,834.54 |
| Max. Negotiated Rate |
$19,763.62 |
| Rate for Payer: Aetna Commercial |
$18,665.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,273.73
|
| Rate for Payer: Cash Price |
$17,567.66
|
| Rate for Payer: Cofinity Commercial |
$15,371.71
|
| Rate for Payer: Cofinity Commercial |
$18,885.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,371.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,567.66
|
| Rate for Payer: Healthscope Commercial |
$19,763.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,665.64
|
| Rate for Payer: PHP Commercial |
$18,665.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,273.73
|
| Rate for Payer: Priority Health SBD |
$13,834.54
|
|
|
HC IR ATHERECTOMY TIB PERONL UNI EACH ADDL
|
Facility
|
OP
|
$9,515.71
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
36100177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,806.28 |
| Max. Negotiated Rate |
$8,564.14 |
| Rate for Payer: Aetna Commercial |
$8,088.35
|
| Rate for Payer: Aetna Medicare |
$4,757.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,185.21
|
| Rate for Payer: BCBS Complete |
$3,806.28
|
| Rate for Payer: Cash Price |
$7,612.57
|
| Rate for Payer: Cofinity Commercial |
$6,661.00
|
| Rate for Payer: Cofinity Commercial |
$8,183.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,661.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,612.57
|
| Rate for Payer: Healthscope Commercial |
$8,564.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,088.35
|
| Rate for Payer: PHP Commercial |
$8,088.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,185.21
|
| Rate for Payer: Priority Health SBD |
$5,994.90
|
|
|
HC IR ATHERECTOMY TIB PERONL UNI EACH ADDL
|
Facility
|
IP
|
$9,515.71
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
36100177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,994.90 |
| Max. Negotiated Rate |
$8,564.14 |
| Rate for Payer: Aetna Commercial |
$8,088.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,185.21
|
| Rate for Payer: Cash Price |
$7,612.57
|
| Rate for Payer: Cofinity Commercial |
$6,661.00
|
| Rate for Payer: Cofinity Commercial |
$8,183.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,661.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,612.57
|
| Rate for Payer: Healthscope Commercial |
$8,564.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,088.35
|
| Rate for Payer: PHP Commercial |
$8,088.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,185.21
|
| Rate for Payer: Priority Health SBD |
$5,994.90
|
|
|
HC IR ATHERECT STENT TIB PERON UN
|
Facility
|
OP
|
$20,088.35
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
36100175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$17,075.10
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,057.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cofinity Commercial |
$17,275.98
|
| Rate for Payer: Cofinity Commercial |
$14,061.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,061.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,070.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$18,079.51
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,075.10
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$17,075.10
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,057.43
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$12,655.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC IR ATHERECT STENT TIB PERON UN
|
Facility
|
IP
|
$20,088.35
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
36100175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,655.66 |
| Max. Negotiated Rate |
$18,079.51 |
| Rate for Payer: Aetna Commercial |
$17,075.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,057.43
|
| Rate for Payer: Cash Price |
$16,070.68
|
| Rate for Payer: Cofinity Commercial |
$14,061.84
|
| Rate for Payer: Cofinity Commercial |
$17,275.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,061.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,070.68
|
| Rate for Payer: Healthscope Commercial |
$18,079.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,075.10
|
| Rate for Payer: PHP Commercial |
$17,075.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,057.43
|
| Rate for Payer: Priority Health SBD |
$12,655.66
|
|
|
HC IR CATHETER
|
Facility
|
IP
|
$44.74
|
|
| Hospital Charge Code |
27200307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC IR CATHETER
|
Facility
|
OP
|
$44.74
|
|
| Hospital Charge Code |
27200307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC IR CATHETER.
|
Facility
|
IP
|
$234.09
|
|
| Hospital Charge Code |
27200308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.48 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$163.86
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health SBD |
$147.48
|
|
|
HC IR CATHETER.
|
Facility
|
OP
|
$234.09
|
|
| Hospital Charge Code |
27200308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna Medicare |
$117.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: BCBS Complete |
$93.64
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$163.86
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health SBD |
$147.48
|
|
|
HC IR CENTRAL LINE CHECK W FLUOROSCOPY
|
Facility
|
IP
|
$555.66
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
36100145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$500.09 |
| Rate for Payer: Aetna Commercial |
$472.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.18
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cofinity Commercial |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$477.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.53
|
| Rate for Payer: Healthscope Commercial |
$500.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.31
|
| Rate for Payer: PHP Commercial |
$472.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.18
|
| Rate for Payer: Priority Health SBD |
$350.07
|
|
|
HC IR CENTRAL LINE CHECK W FLUOROSCOPY
|
Facility
|
OP
|
$555.66
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
36100145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna Commercial |
$472.31
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cofinity Commercial |
$477.87
|
| Rate for Payer: Cofinity Commercial |
$388.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$500.09
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.31
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$472.31
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.18
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$350.07
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$115.69
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IR CYSTOSTOMY WITH DRAINAGE
|
Facility
|
IP
|
$3,560.77
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
36100398
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,243.29 |
| Max. Negotiated Rate |
$3,204.69 |
| Rate for Payer: Aetna Commercial |
$3,026.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,314.50
|
| Rate for Payer: Cash Price |
$2,848.62
|
| Rate for Payer: Cofinity Commercial |
$2,492.54
|
| Rate for Payer: Cofinity Commercial |
$3,062.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,492.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,848.62
|
| Rate for Payer: Healthscope Commercial |
$3,204.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,026.65
|
| Rate for Payer: PHP Commercial |
$3,026.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.50
|
| Rate for Payer: Priority Health SBD |
$2,243.29
|
|
|
HC IR CYSTOSTOMY WITH DRAINAGE
|
Facility
|
OP
|
$3,560.77
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
36100398
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$3,026.65
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,314.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,848.62
|
| Rate for Payer: Cash Price |
$2,848.62
|
| Rate for Payer: Cofinity Commercial |
$3,062.26
|
| Rate for Payer: Cofinity Commercial |
$2,492.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,492.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,848.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$3,204.69
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,026.65
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$3,026.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.50
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$2,243.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC IR DISKOGRAM CERVICAL THORACIC
|
Facility
|
IP
|
$2,558.14
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
32000057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,611.63 |
| Max. Negotiated Rate |
$2,302.33 |
| Rate for Payer: Aetna Commercial |
$2,174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,662.79
|
| Rate for Payer: Cash Price |
$2,046.51
|
| Rate for Payer: Cofinity Commercial |
$1,790.70
|
| Rate for Payer: Cofinity Commercial |
$2,200.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,790.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,046.51
|
| Rate for Payer: Healthscope Commercial |
$2,302.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,174.42
|
| Rate for Payer: PHP Commercial |
$2,174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.79
|
| Rate for Payer: Priority Health SBD |
$1,611.63
|
|
|
HC IR DISKOGRAM CERVICAL THORACIC
|
Facility
|
OP
|
$2,558.14
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
32000057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Commercial |
$2,174.42
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,662.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$2,046.51
|
| Rate for Payer: Cash Price |
$2,046.51
|
| Rate for Payer: Cofinity Commercial |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,790.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,790.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,046.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,302.33
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,174.42
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,174.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.79
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,611.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Core |
$1,893.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$1,893.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
IP
|
$2,929.03
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,845.29 |
| Max. Negotiated Rate |
$2,636.13 |
| Rate for Payer: Aetna Commercial |
$2,489.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.87
|
| Rate for Payer: Cash Price |
$2,343.22
|
| Rate for Payer: Cofinity Commercial |
$2,050.32
|
| Rate for Payer: Cofinity Commercial |
$2,518.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,050.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,343.22
|
| Rate for Payer: Healthscope Commercial |
$2,636.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.68
|
| Rate for Payer: PHP Commercial |
$2,489.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.87
|
| Rate for Payer: Priority Health SBD |
$1,845.29
|
|
|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
OP
|
$2,929.03
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Commercial |
$2,489.68
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$2,343.22
|
| Rate for Payer: Cash Price |
$2,343.22
|
| Rate for Payer: Cofinity Commercial |
$2,050.32
|
| Rate for Payer: Cofinity Commercial |
$2,518.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,050.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,343.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,636.13
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.68
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,489.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.87
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,845.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Core |
$2,167.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,167.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
HC IR EMBOLIZATION
|
Facility
|
OP
|
$3,499.53
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,399.81 |
| Max. Negotiated Rate |
$3,149.58 |
| Rate for Payer: Aetna Commercial |
$2,974.60
|
| Rate for Payer: Aetna Medicare |
$1,749.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.69
|
| Rate for Payer: BCBS Complete |
$1,399.81
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cofinity Commercial |
$2,449.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,449.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.62
|
| Rate for Payer: Healthscope Commercial |
$3,149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.60
|
| Rate for Payer: PHP Commercial |
$2,974.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,274.69
|
| Rate for Payer: Priority Health SBD |
$2,204.70
|
| Rate for Payer: UHC Core |
$2,589.65
|
| Rate for Payer: UHC Exchange |
$2,589.65
|
|
|
HC IR EMBOLIZATION
|
Facility
|
IP
|
$3,499.53
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,204.70 |
| Max. Negotiated Rate |
$3,149.58 |
| Rate for Payer: Aetna Commercial |
$2,974.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.69
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cofinity Commercial |
$2,449.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,449.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.62
|
| Rate for Payer: Healthscope Commercial |
$3,149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.60
|
| Rate for Payer: PHP Commercial |
$2,974.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,274.69
|
| Rate for Payer: Priority Health SBD |
$2,204.70
|
|
|
HC IR ERCP
|
Facility
|
OP
|
$816.66
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.66 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna Commercial |
$694.16
|
| Rate for Payer: Aetna Medicare |
$408.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.83
|
| Rate for Payer: BCBS Complete |
$326.66
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$571.66
|
| Rate for Payer: Cofinity Commercial |
$702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Healthscope Commercial |
$734.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: PHP Commercial |
$694.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health SBD |
$514.50
|
| Rate for Payer: UHC Core |
$604.33
|
| Rate for Payer: UHC Exchange |
$604.33
|
|
|
HC IR ERCP
|
Facility
|
IP
|
$816.66
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna Commercial |
$694.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.83
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$571.66
|
| Rate for Payer: Cofinity Commercial |
$702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Healthscope Commercial |
$734.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: PHP Commercial |
$694.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health SBD |
$514.50
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
IP
|
$628.94
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.23 |
| Max. Negotiated Rate |
$566.05 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.81
|
| Rate for Payer: Cash Price |
$503.15
|
| Rate for Payer: Cofinity Commercial |
$440.26
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$440.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.15
|
| Rate for Payer: Healthscope Commercial |
$566.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.60
|
| Rate for Payer: PHP Commercial |
$534.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.81
|
| Rate for Payer: Priority Health SBD |
$396.23
|
|
