|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health SBD |
$257.17
|
|
|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$1,505.27 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Core |
$302.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$302.07
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$301.06
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
IP
|
$1,568.04
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$987.87 |
| Max. Negotiated Rate |
$1,411.24 |
| Rate for Payer: Aetna Commercial |
$1,332.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.23
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,097.63
|
| Rate for Payer: Cofinity Commercial |
$1,348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Healthscope Commercial |
$1,411.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: PHP Commercial |
$1,332.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: Priority Health SBD |
$987.87
|
|
|
HC IR SPHENOID ELECTRODE PLACEMENT
|
Facility
|
OP
|
$1,568.04
|
|
|
Service Code
|
CPT 95830
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$627.22 |
| Max. Negotiated Rate |
$1,411.24 |
| Rate for Payer: Aetna Commercial |
$1,332.83
|
| Rate for Payer: Aetna Medicare |
$784.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.23
|
| Rate for Payer: BCBS Complete |
$627.22
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,097.63
|
| Rate for Payer: Cofinity Commercial |
$1,348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Healthscope Commercial |
$1,411.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: PHP Commercial |
$1,332.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: Priority Health SBD |
$987.87
|
| Rate for Payer: UHC Exchange |
$1,160.35
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
OP
|
$3,801.67
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,395.05 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Commercial |
$3,231.42
|
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cofinity Commercial |
$3,269.44
|
| Rate for Payer: Cofinity Commercial |
$2,661.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,661.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Healthscope Commercial |
$3,421.50
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,231.42
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Commercial |
$3,231.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,471.09
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Priority Health SBD |
$2,395.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Core |
$2,813.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$2,813.24
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,968.18
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
HC IR SPINAL ANGIOGRAPHY
|
Facility
|
IP
|
$3,801.67
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,395.05 |
| Max. Negotiated Rate |
$3,421.50 |
| Rate for Payer: Aetna Commercial |
$3,231.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.09
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cofinity Commercial |
$2,661.17
|
| Rate for Payer: Cofinity Commercial |
$3,269.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,661.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.34
|
| Rate for Payer: Healthscope Commercial |
$3,421.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,231.42
|
| Rate for Payer: PHP Commercial |
$3,231.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,471.09
|
| Rate for Payer: Priority Health SBD |
$2,395.05
|
|
|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
IP
|
$2,654.21
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,672.15 |
| Max. Negotiated Rate |
$2,388.79 |
| Rate for Payer: Aetna Commercial |
$2,256.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.24
|
| Rate for Payer: Cash Price |
$2,123.37
|
| Rate for Payer: Cofinity Commercial |
$1,857.95
|
| Rate for Payer: Cofinity Commercial |
$2,282.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,857.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,123.37
|
| Rate for Payer: Healthscope Commercial |
$2,388.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,256.08
|
| Rate for Payer: PHP Commercial |
$2,256.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.24
|
| Rate for Payer: Priority Health SBD |
$1,672.15
|
|
|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
OP
|
$2,654.21
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$4,264.69 |
| Rate for Payer: Aetna Commercial |
$2,256.08
|
| Rate for Payer: Aetna Medicare |
$1,575.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$2,123.37
|
| Rate for Payer: Cash Price |
$2,123.37
|
| Rate for Payer: Cofinity Commercial |
$2,282.62
|
| Rate for Payer: Cofinity Commercial |
$1,857.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,857.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,123.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$2,388.79
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,256.08
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$2,256.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.24
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health SBD |
$1,672.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.69
|
| Rate for Payer: UHC Core |
$1,964.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$1,964.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$852.97
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC IR THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$8,462.96
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,331.66 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$7,193.52
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,500.92
|
| 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 |
$6,770.37
|
| Rate for Payer: Cash Price |
$6,770.37
|
| Rate for Payer: Cofinity Commercial |
$7,278.15
|
| Rate for Payer: Cofinity Commercial |
$5,924.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,924.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,770.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$7,616.66
|
| 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 |
$7,193.52
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$7,193.52
|
| 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 |
$5,500.92
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$5,331.66
|
| 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 THROMBECTOMY 1ST ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$8,462.96
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
36100149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,331.66 |
| Max. Negotiated Rate |
$7,616.66 |
| Rate for Payer: Aetna Commercial |
$7,193.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,500.92
|
| Rate for Payer: Cash Price |
$6,770.37
|
| Rate for Payer: Cofinity Commercial |
$5,924.07
|
| Rate for Payer: Cofinity Commercial |
$7,278.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,924.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,770.37
|
| Rate for Payer: Healthscope Commercial |
$7,616.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,193.52
|
| Rate for Payer: PHP Commercial |
$7,193.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,500.92
|
| Rate for Payer: Priority Health SBD |
$5,331.66
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
OP
|
$2,403.79
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$961.52 |
| Max. Negotiated Rate |
$2,163.41 |
| Rate for Payer: Aetna Commercial |
$2,043.22
|
| Rate for Payer: Aetna Medicare |
$1,201.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,562.46
|
| Rate for Payer: BCBS Complete |
$961.52
|
| Rate for Payer: Cash Price |
$1,923.03
|
| Rate for Payer: Cofinity Commercial |
$1,682.65
|
| Rate for Payer: Cofinity Commercial |
$2,067.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,682.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,923.03
|
| Rate for Payer: Healthscope Commercial |
$2,163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,043.22
|
| Rate for Payer: PHP Commercial |
$2,043.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.46
|
| Rate for Payer: Priority Health SBD |
$1,514.39
|
|
|
HC IR THROMBECTOMY 2ND ARTERIAL GRAFT W FLUOROSCPY
|
Facility
|
IP
|
$2,403.79
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
36100151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,514.39 |
| Max. Negotiated Rate |
$2,163.41 |
| Rate for Payer: Aetna Commercial |
$2,043.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,562.46
|
| Rate for Payer: Cash Price |
$1,923.03
|
| Rate for Payer: Cofinity Commercial |
$1,682.65
|
| Rate for Payer: Cofinity Commercial |
$2,067.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,682.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,923.03
|
| Rate for Payer: Healthscope Commercial |
$2,163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,043.22
|
| Rate for Payer: PHP Commercial |
$2,043.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.46
|
| Rate for Payer: Priority Health SBD |
$1,514.39
|
|
|
HC IR THROMBECTOMY ARTERIAL GRAFT 2ND AND SUBSEQUENT VESSELS
|
Facility
|
OP
|
$5,718.04
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
36100150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,287.22 |
| Max. Negotiated Rate |
$5,146.24 |
| Rate for Payer: Aetna Commercial |
$4,860.33
|
| Rate for Payer: Aetna Medicare |
$2,859.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,716.73
|
| Rate for Payer: BCBS Complete |
$2,287.22
|
| Rate for Payer: Cash Price |
$4,574.43
|
| Rate for Payer: Cofinity Commercial |
$4,002.63
|
| Rate for Payer: Cofinity Commercial |
$4,917.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,002.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,574.43
|
| Rate for Payer: Healthscope Commercial |
$5,146.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,860.33
|
| Rate for Payer: PHP Commercial |
$4,860.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,716.73
|
| Rate for Payer: Priority Health SBD |
$3,602.37
|
|
|
HC IR THROMBECTOMY ARTERIAL GRAFT 2ND AND SUBSEQUENT VESSELS
|
Facility
|
IP
|
$5,718.04
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
36100150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,602.37 |
| Max. Negotiated Rate |
$5,146.24 |
| Rate for Payer: Aetna Commercial |
$4,860.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,716.73
|
| Rate for Payer: Cash Price |
$4,574.43
|
| Rate for Payer: Cofinity Commercial |
$4,002.63
|
| Rate for Payer: Cofinity Commercial |
$4,917.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,002.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,574.43
|
| Rate for Payer: Healthscope Commercial |
$5,146.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,860.33
|
| Rate for Payer: PHP Commercial |
$4,860.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,716.73
|
| Rate for Payer: Priority Health SBD |
$3,602.37
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY
|
Facility
|
IP
|
$7,442.25
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
36100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.62 |
| Max. Negotiated Rate |
$6,698.02 |
| Rate for Payer: Aetna Commercial |
$6,325.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,837.46
|
| Rate for Payer: Cash Price |
$5,953.80
|
| Rate for Payer: Cofinity Commercial |
$5,209.57
|
| Rate for Payer: Cofinity Commercial |
$6,400.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,209.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,953.80
|
| Rate for Payer: Healthscope Commercial |
$6,698.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,325.91
|
| Rate for Payer: PHP Commercial |
$6,325.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,837.46
|
| Rate for Payer: Priority Health SBD |
$4,688.62
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY
|
Facility
|
OP
|
$7,442.25
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
36100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.62 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$6,325.91
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,837.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$5,953.80
|
| Rate for Payer: Cash Price |
$5,953.80
|
| Rate for Payer: Cofinity Commercial |
$6,400.34
|
| Rate for Payer: Cofinity Commercial |
$5,209.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,209.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,953.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$6,698.02
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,325.91
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$6,325.91
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,837.46
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$4,688.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY SUBSEQUENT DAY
|
Facility
|
OP
|
$5,369.59
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
36100153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$4,564.15
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,490.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$4,295.67
|
| Rate for Payer: Cash Price |
$4,295.67
|
| Rate for Payer: Cofinity Commercial |
$4,617.85
|
| Rate for Payer: Cofinity Commercial |
$3,758.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,758.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,295.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,832.63
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,564.15
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$4,564.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,490.23
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$3,382.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC IR THROMBECTOMY VENOUS WITH FLUOROSCOPY SUBSEQUENT DAY
|
Facility
|
IP
|
$5,369.59
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
36100153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,382.84 |
| Max. Negotiated Rate |
$4,832.63 |
| Rate for Payer: Aetna Commercial |
$4,564.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,490.23
|
| Rate for Payer: Cash Price |
$4,295.67
|
| Rate for Payer: Cofinity Commercial |
$3,758.71
|
| Rate for Payer: Cofinity Commercial |
$4,617.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,758.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,295.67
|
| Rate for Payer: Healthscope Commercial |
$4,832.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,564.15
|
| Rate for Payer: PHP Commercial |
$4,564.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,490.23
|
| Rate for Payer: Priority Health SBD |
$3,382.84
|
|
|
HC IR TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$1,798.46
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,133.03 |
| Max. Negotiated Rate |
$1,618.61 |
| Rate for Payer: Aetna Commercial |
$1,528.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.00
|
| Rate for Payer: Cash Price |
$1,438.77
|
| Rate for Payer: Cofinity Commercial |
$1,258.92
|
| Rate for Payer: Cofinity Commercial |
$1,546.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,258.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,438.77
|
| Rate for Payer: Healthscope Commercial |
$1,618.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,528.69
|
| Rate for Payer: PHP Commercial |
$1,528.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.00
|
| Rate for Payer: Priority Health SBD |
$1,133.03
|
|
|
HC IR TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$1,798.46
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$719.38 |
| Max. Negotiated Rate |
$1,618.61 |
| Rate for Payer: Aetna Commercial |
$1,528.69
|
| Rate for Payer: Aetna Medicare |
$899.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.00
|
| Rate for Payer: BCBS Complete |
$719.38
|
| Rate for Payer: Cash Price |
$1,438.77
|
| Rate for Payer: Cofinity Commercial |
$1,258.92
|
| Rate for Payer: Cofinity Commercial |
$1,546.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,258.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,438.77
|
| Rate for Payer: Healthscope Commercial |
$1,618.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,528.69
|
| Rate for Payer: PHP Commercial |
$1,528.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.00
|
| Rate for Payer: Priority Health SBD |
$1,133.03
|
| Rate for Payer: UHC Core |
$1,330.86
|
| Rate for Payer: UHC Exchange |
$1,330.86
|
|
|
HC IR UNLISTED URINARY SYSTEM
|
Facility
|
OP
|
$2,172.48
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
36100254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,846.61
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.11
|
| 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 |
$1,737.98
|
| Rate for Payer: Cash Price |
$1,737.98
|
| Rate for Payer: Cofinity Commercial |
$1,868.33
|
| Rate for Payer: Cofinity Commercial |
$1,520.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,520.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,737.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$1,955.23
|
| 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 |
$1,846.61
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$1,846.61
|
| 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 |
$1,412.11
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$1,368.66
|
| 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 IR UNLISTED URINARY SYSTEM
|
Facility
|
IP
|
$2,172.48
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
36100254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,368.66 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,846.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.11
|
| Rate for Payer: Cash Price |
$1,737.98
|
| Rate for Payer: Cofinity Commercial |
$1,520.74
|
| Rate for Payer: Cofinity Commercial |
$1,868.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,520.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,737.98
|
| Rate for Payer: Healthscope Commercial |
$1,955.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,846.61
|
| Rate for Payer: PHP Commercial |
$1,846.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.11
|
| Rate for Payer: Priority Health SBD |
$1,368.66
|
|
|
HC IR UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$463.43
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$980.43 |
| Rate for Payer: Aetna Commercial |
$393.92
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$370.74
|
| Rate for Payer: Cash Price |
$370.74
|
| Rate for Payer: Cofinity Commercial |
$398.55
|
| Rate for Payer: Cofinity Commercial |
$324.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$417.09
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.92
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$393.92
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.23
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$291.96
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$342.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$342.94
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC IR UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$463.43
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.96 |
| Max. Negotiated Rate |
$417.09 |
| Rate for Payer: Aetna Commercial |
$393.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.23
|
| Rate for Payer: Cash Price |
$370.74
|
| Rate for Payer: Cofinity Commercial |
$324.40
|
| Rate for Payer: Cofinity Commercial |
$398.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.74
|
| Rate for Payer: Healthscope Commercial |
$417.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.92
|
| Rate for Payer: PHP Commercial |
$393.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.23
|
| Rate for Payer: Priority Health SBD |
$291.96
|
|
|
HC IR US GUIDED VASC ACCESS
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$225.15 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
