|
HC IR REVASCULARIZATION PLASTY TIB PERO UNI E
|
Facility
|
OP
|
$7,584.04
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
36100176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,033.62 |
| Max. Negotiated Rate |
$6,825.64 |
| Rate for Payer: Aetna Commercial |
$6,446.43
|
| Rate for Payer: Aetna Medicare |
$3,792.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,929.63
|
| Rate for Payer: BCBS Complete |
$3,033.62
|
| Rate for Payer: Cash Price |
$6,067.23
|
| Rate for Payer: Cofinity Commercial |
$5,308.83
|
| Rate for Payer: Cofinity Commercial |
$6,522.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,308.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,067.23
|
| Rate for Payer: Healthscope Commercial |
$6,825.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,446.43
|
| Rate for Payer: PHP Commercial |
$6,446.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,929.63
|
| Rate for Payer: Priority Health SBD |
$4,777.95
|
|
|
HC IR REVASCULARIZATION STENT ILIAC UNI EACH ADDL
|
Facility
|
IP
|
$12,376.21
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
36100167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,797.01 |
| Max. Negotiated Rate |
$11,138.59 |
| Rate for Payer: Aetna Commercial |
$10,519.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,044.54
|
| Rate for Payer: Cash Price |
$9,900.97
|
| Rate for Payer: Cofinity Commercial |
$10,643.54
|
| Rate for Payer: Cofinity Commercial |
$8,663.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,663.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,900.97
|
| Rate for Payer: Healthscope Commercial |
$11,138.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,519.78
|
| Rate for Payer: PHP Commercial |
$10,519.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,044.54
|
| Rate for Payer: Priority Health SBD |
$7,797.01
|
|
|
HC IR REVASCULARIZATION STENT ILIAC UNI EACH ADDL
|
Facility
|
OP
|
$12,376.21
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
36100167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,950.48 |
| Max. Negotiated Rate |
$11,138.59 |
| Rate for Payer: Aetna Commercial |
$10,519.78
|
| Rate for Payer: Aetna Medicare |
$6,188.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,044.54
|
| Rate for Payer: BCBS Complete |
$4,950.48
|
| Rate for Payer: Cash Price |
$9,900.97
|
| Rate for Payer: Cofinity Commercial |
$10,643.54
|
| Rate for Payer: Cofinity Commercial |
$8,663.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,663.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,900.97
|
| Rate for Payer: Healthscope Commercial |
$11,138.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,519.78
|
| Rate for Payer: PHP Commercial |
$10,519.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,044.54
|
| Rate for Payer: Priority Health SBD |
$7,797.01
|
|
|
HC IR REVASCULARIZATION STENT TIB PERONL UNI EACH ADDL
|
Facility
|
OP
|
$10,518.95
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
36100178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,207.58 |
| Max. Negotiated Rate |
$9,467.06 |
| Rate for Payer: Aetna Commercial |
$8,941.11
|
| Rate for Payer: Aetna Medicare |
$5,259.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,837.32
|
| Rate for Payer: BCBS Complete |
$4,207.58
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$7,363.27
|
| Rate for Payer: Cofinity Commercial |
$9,046.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,363.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$9,467.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: PHP Commercial |
$8,941.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,837.32
|
| Rate for Payer: Priority Health SBD |
$6,626.94
|
|
|
HC IR REVASCULARIZATION STENT TIB PERONL UNI EACH ADDL
|
Facility
|
IP
|
$10,518.95
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
36100178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,626.94 |
| Max. Negotiated Rate |
$9,467.06 |
| Rate for Payer: Aetna Commercial |
$8,941.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,837.32
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$7,363.27
|
| Rate for Payer: Cofinity Commercial |
$9,046.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,363.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$9,467.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: PHP Commercial |
$8,941.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,837.32
|
| Rate for Payer: Priority Health SBD |
$6,626.94
|
|
|
HC IR REVISION TIPS WITH FLUORO
|
Facility
|
IP
|
$11,383.98
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
36100148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,171.91 |
| Max. Negotiated Rate |
$10,245.58 |
| Rate for Payer: Aetna Commercial |
$9,676.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,399.59
|
| Rate for Payer: Cash Price |
$9,107.18
|
| Rate for Payer: Cofinity Commercial |
$7,968.79
|
| Rate for Payer: Cofinity Commercial |
$9,790.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,968.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,107.18
|
| Rate for Payer: Healthscope Commercial |
$10,245.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,676.38
|
| Rate for Payer: PHP Commercial |
$9,676.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,399.59
|
| Rate for Payer: Priority Health SBD |
$7,171.91
|
|
|
HC IR REVISION TIPS WITH FLUORO
|
Facility
|
OP
|
$11,383.98
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
36100148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,980.47 |
| Max. Negotiated Rate |
$15,652.48 |
| Rate for Payer: Aetna Commercial |
$9,676.38
|
| Rate for Payer: Aetna Medicare |
$5,783.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,399.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,950.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,950.73
|
| Rate for Payer: BCBS Complete |
$3,129.49
|
| Rate for Payer: BCBS MAPPO |
$5,560.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,560.58
|
| Rate for Payer: Cash Price |
$9,107.18
|
| Rate for Payer: Cash Price |
$9,107.18
|
| Rate for Payer: Cofinity Commercial |
$7,968.79
|
| Rate for Payer: Cofinity Commercial |
$9,790.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,968.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,107.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,560.58
|
| Rate for Payer: Healthscope Commercial |
$10,245.58
|
| Rate for Payer: Mclaren Medicaid |
$2,980.47
|
| Rate for Payer: Mclaren Medicare |
$5,560.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,838.61
|
| Rate for Payer: Meridian Medicaid |
$3,129.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,394.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,676.38
|
| Rate for Payer: PACE Medicare |
$5,282.55
|
| Rate for Payer: PACE SWMI |
$5,560.58
|
| Rate for Payer: PHP Commercial |
$9,676.38
|
| Rate for Payer: PHP Medicare Advantage |
$5,560.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,399.59
|
| Rate for Payer: Priority Health Medicare |
$5,560.58
|
| Rate for Payer: Priority Health SBD |
$7,171.91
|
| Rate for Payer: Railroad Medicare Medicare |
$5,560.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,652.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,560.58
|
| Rate for Payer: UHCCP Medicaid |
$3,130.61
|
| Rate for Payer: VA VA |
$5,560.58
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
OP
|
$182.25
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$164.03 |
| Rate for Payer: Aetna Commercial |
$154.91
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Cofinity Commercial |
$156.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$164.03
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.91
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$154.91
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.46
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$114.82
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
IP
|
$182.25
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.82 |
| Max. Negotiated Rate |
$164.03 |
| Rate for Payer: Aetna Commercial |
$154.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.46
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Cofinity Commercial |
$156.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.80
|
| Rate for Payer: Healthscope Commercial |
$164.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.91
|
| Rate for Payer: PHP Commercial |
$154.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.46
|
| Rate for Payer: Priority Health SBD |
$114.82
|
|
|
HC IRRIGATION CONE
|
Facility
|
OP
|
$43.61
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Aetna Medicare |
$21.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.35
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: Cash Price |
$34.89
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$37.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.89
|
| Rate for Payer: Healthscope Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.07
|
| Rate for Payer: PHP Commercial |
$37.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health SBD |
$27.47
|
|
|
HC IRRIGATION CONE
|
Facility
|
IP
|
$43.61
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.35
|
| Rate for Payer: Cash Price |
$34.89
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$37.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.89
|
| Rate for Payer: Healthscope Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.07
|
| Rate for Payer: PHP Commercial |
$37.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health SBD |
$27.47
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.52 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.75
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$252.81
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health SBD |
$227.52
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Commercial |
$252.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$227.52
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
IP
|
$18.07
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
IP
|
$1,959.74
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,234.64 |
| Max. Negotiated Rate |
$1,763.77 |
| Rate for Payer: Aetna Commercial |
$1,665.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.83
|
| Rate for Payer: Cash Price |
$1,567.79
|
| Rate for Payer: Cofinity Commercial |
$1,371.82
|
| Rate for Payer: Cofinity Commercial |
$1,685.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.79
|
| Rate for Payer: Healthscope Commercial |
$1,763.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.78
|
| Rate for Payer: PHP Commercial |
$1,665.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.83
|
| Rate for Payer: Priority Health SBD |
$1,234.64
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
OP
|
$1,959.74
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$783.90 |
| Max. Negotiated Rate |
$1,763.77 |
| Rate for Payer: Aetna Commercial |
$1,665.78
|
| Rate for Payer: Aetna Medicare |
$979.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.83
|
| Rate for Payer: BCBS Complete |
$783.90
|
| Rate for Payer: Cash Price |
$1,567.79
|
| Rate for Payer: Cofinity Commercial |
$1,371.82
|
| Rate for Payer: Cofinity Commercial |
$1,685.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.79
|
| Rate for Payer: Healthscope Commercial |
$1,763.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.78
|
| Rate for Payer: PHP Commercial |
$1,665.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.83
|
| Rate for Payer: Priority Health SBD |
$1,234.64
|
| Rate for Payer: UHC Core |
$1,450.21
|
| Rate for Payer: UHC Exchange |
$1,450.21
|
|
|
HC IR SHEATH
|
Facility
|
IP
|
$234.09
|
|
| Hospital Charge Code |
27200314
|
|
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 SHEATH
|
Facility
|
OP
|
$234.09
|
|
| Hospital Charge Code |
27200314
|
|
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 SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
OP
|
$729.07
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$656.16 |
| Rate for Payer: Aetna Commercial |
$619.71
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$583.26
|
| Rate for Payer: Cash Price |
$583.26
|
| Rate for Payer: Cofinity Commercial |
$627.00
|
| Rate for Payer: Cofinity Commercial |
$510.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$656.16
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.71
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$619.71
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$459.31
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$539.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$539.51
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
IP
|
$729.07
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$459.31 |
| Max. Negotiated Rate |
$656.16 |
| Rate for Payer: Aetna Commercial |
$619.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.90
|
| Rate for Payer: Cash Price |
$583.26
|
| Rate for Payer: Cofinity Commercial |
$510.35
|
| Rate for Payer: Cofinity Commercial |
$627.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.26
|
| Rate for Payer: Healthscope Commercial |
$656.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.71
|
| Rate for Payer: PHP Commercial |
$619.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health SBD |
$459.31
|
|
|
HC IR SIALOGRAM
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health SBD |
$367.47
|
|
|
HC IR SIALOGRAM
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$367.47
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$431.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$431.63
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC IR SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$975.38
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| 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 SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$975.38
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna Commercial |
$829.07
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$877.84
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.07
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$829.07
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.00
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$614.49
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$380.25
|
| Rate for Payer: VA VA |
$675.40
|
|
