|
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 |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.80
|
| 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 |
$31.88 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$138.31
|
| Rate for Payer: BCN Commercial |
$138.31
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$288.92
|
| 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 |
$252.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$227.52
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
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
|
OP
|
$1,959.74
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.18 |
| 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: BCBS Trust/PPO |
$96.18
|
| Rate for Payer: BCN Commercial |
$96.18
|
| Rate for Payer: Cash Price |
$1,567.79
|
| 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 All Payor (Choice/PPO) |
$98.91
|
| Rate for Payer: UHC Exchange |
$1,450.21
|
|
|
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 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 |
$117.04
|
| 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 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 SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
OP
|
$729.07
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$656.16 |
| Rate for Payer: Aetna Commercial |
$619.71
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$111.89
|
| Rate for Payer: BCN Commercial |
$111.89
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$656.16
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.71
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$619.71
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$459.31
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$539.51
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
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 |
$115.36 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| 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 |
$184.81
|
| Rate for Payer: BCN Commercial |
$184.81
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| 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 |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| 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 |
$495.79
|
| 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 |
$495.79
|
| 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 |
$379.13
|
| 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 |
$367.47
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$431.63
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
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 |
$85.93 |
| 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: BCBS Trust/PPO |
$308.50
|
| Rate for Payer: BCN Commercial |
$308.50
|
| 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 |
$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: 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) |
$85.93
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
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 SINAGRAM FISTULAGRAM
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| 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 |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$302.07
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
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 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 |
$95.69 |
| Max. Negotiated Rate |
$2,773.11 |
| 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: BCBS Trust/PPO |
$2,773.11
|
| Rate for Payer: BCN Commercial |
$2,773.11
|
| Rate for Payer: Cash Price |
$1,254.43
|
| 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 All Payor (Choice/PPO) |
$95.69
|
| Rate for Payer: UHC Exchange |
$1,160.35
|
|
|
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 SPINAL ANGIOGRAPHY
|
Facility
|
OP
|
$3,801.67
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Commercial |
$3,231.42
|
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$255.85
|
| Rate for Payer: BCN Commercial |
$255.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| 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 |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$3,421.50
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,231.42
|
| Rate for Payer: Nomi Health Commercial |
$15,889.20
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$3,231.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,471.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Priority Health SBD |
$2,395.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$2,813.24
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,981.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC IR SUPERIOR VENACAVAGRAM
|
Facility
|
OP
|
$2,654.21
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
32000206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.79 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Commercial |
$2,256.08
|
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$124.46
|
| Rate for Payer: BCN Commercial |
$124.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| 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 |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$2,388.79
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,256.08
|
| Rate for Payer: Nomi Health Commercial |
$4,566.09
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$2,256.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Priority Health SBD |
$1,672.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$1,964.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$856.90
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
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 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
|
|
