|
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
|
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 |
$117.04
|
| 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 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 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 |
$37.16 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$472.31
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$132.97
|
| Rate for Payer: BCN Commercial |
$132.97
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cash Price |
$444.53
|
| 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: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$500.09
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.31
|
| Rate for Payer: Nomi Health Commercial |
$433.50
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$472.31
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$350.07
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.16
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$116.22
|
| Rate for Payer: VA VA |
$206.43
|
|
|
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 |
$308.34 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$3,026.65
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,314.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$953.23
|
| Rate for Payer: BCN Commercial |
$953.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,848.62
|
| Rate for Payer: Cash Price |
$2,848.62
|
| 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: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$3,204.69
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,026.65
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$3,026.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$2,243.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.34
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
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 |
$134.13 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Commercial |
$2,174.42
|
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,662.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$145.21
|
| Rate for Payer: BCN Commercial |
$145.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| 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 |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$2,302.33
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,174.42
|
| Rate for Payer: Nomi Health Commercial |
$5,739.84
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,174.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Priority Health SBD |
$1,611.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$1,893.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,077.18
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
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 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 |
$112.73 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Commercial |
$2,489.68
|
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$136.41
|
| Rate for Payer: BCN Commercial |
$136.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$2,343.22
|
| Rate for Payer: Cash Price |
$2,343.22
|
| Rate for Payer: Cofinity Commercial |
$2,518.97
|
| Rate for Payer: Cofinity Commercial |
$2,050.32
|
| 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 |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$2,636.13
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.68
|
| Rate for Payer: Nomi Health Commercial |
$5,739.84
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,489.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Priority Health SBD |
$1,845.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,167.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,077.18
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
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 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 |
$1,749.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.69
|
| Rate for Payer: BCBS Complete |
$1,399.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,743.19
|
| Rate for Payer: BCN Commercial |
$1,743.19
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cofinity Commercial |
$3,009.60
|
| Rate for Payer: Cofinity Commercial |
$2,449.67
|
| 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 Exchange |
$2,589.65
|
|
|
HC IR ERCP
|
Facility
|
OP
|
$816.66
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.41 |
| 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: BCBS Trust/PPO |
$136.41
|
| Rate for Payer: BCN Commercial |
$136.41
|
| Rate for Payer: Cash Price |
$653.33
|
| 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 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
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
OP
|
$628.94
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.58 |
| Max. Negotiated Rate |
$566.05 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Medicare |
$314.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.81
|
| Rate for Payer: BCBS Complete |
$251.58
|
| Rate for Payer: BCBS Trust/PPO |
$387.23
|
| Rate for Payer: BCN Commercial |
$387.23
|
| Rate for Payer: Cash Price |
$503.15
|
| Rate for Payer: Cash Price |
$503.15
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Cofinity Commercial |
$440.26
|
| 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
|
| Rate for Payer: UHC Exchange |
$465.42
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
OP
|
$306.43
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.81 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna Medicare |
$153.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.18
|
| Rate for Payer: BCBS Complete |
$122.57
|
| Rate for Payer: BCBS Trust/PPO |
$152.75
|
| Rate for Payer: BCN Commercial |
$152.75
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Cofinity Commercial |
$214.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health SBD |
$193.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.81
|
| Rate for Payer: UHC Exchange |
$226.76
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
IP
|
$306.43
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.18
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$214.50
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health SBD |
$193.05
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$505.43 |
| Rate for Payer: Aetna Commercial |
$477.35
|
| Rate for Payer: Aetna Medicare |
$280.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.03
|
| Rate for Payer: BCBS Complete |
$224.64
|
| Rate for Payer: BCBS Trust/PPO |
$145.21
|
| Rate for Payer: BCN Commercial |
$145.21
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$393.11
|
| Rate for Payer: Cofinity Commercial |
$482.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: PHP Commercial |
$477.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health SBD |
$353.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.08
|
| Rate for Payer: UHC Exchange |
$415.58
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
IP
|
$561.59
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.80 |
| Max. Negotiated Rate |
$505.43 |
| Rate for Payer: Aetna Commercial |
$477.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.03
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$393.11
|
| Rate for Payer: Cofinity Commercial |
$482.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: PHP Commercial |
$477.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health SBD |
$353.80
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$477.35
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$482.97
|
| Rate for Payer: Cofinity Commercial |
$393.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$505.43
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$477.35
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$353.80
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$415.58
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
IP
|
$561.59
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.80 |
| Max. Negotiated Rate |
$505.43 |
| Rate for Payer: Aetna Commercial |
$477.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.03
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$393.11
|
| Rate for Payer: Cofinity Commercial |
$482.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: PHP Commercial |
$477.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health SBD |
$353.80
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$975.38
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$614.49 |
| Max. Negotiated Rate |
$877.84 |
| Rate for Payer: Aetna Commercial |
$829.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.00
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cofinity Commercial |
$682.77
|
| Rate for Payer: Cofinity Commercial |
$838.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.30
|
| Rate for Payer: Healthscope Commercial |
$877.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.07
|
| Rate for Payer: PHP Commercial |
$829.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.00
|
| Rate for Payer: Priority Health SBD |
$614.49
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$975.38
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$829.07
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cofinity Commercial |
$838.83
|
| Rate for Payer: Cofinity Commercial |
$682.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$877.84
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.07
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$829.07
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$614.49
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
