|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,129.16 |
| Max. Negotiated Rate |
$1,613.09 |
| Rate for Payer: Aetna Commercial |
$1,523.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.01
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Advantage |
$1,254.62
|
| Rate for Payer: Cofinity Commercial |
$1,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Healthscope Commercial |
$1,613.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: PHP Commercial |
$1,523.47
|
| Rate for Payer: Priority Health SBD |
$1,129.16
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$561.80
|
| Rate for Payer: BCN Commercial |
$561.80
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.79
|
| Rate for Payer: UHC Core |
$885.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$667.97
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,070.80 |
| Max. Negotiated Rate |
$1,529.71 |
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$1,057.03
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$332.38
|
| Rate for Payer: BCN Commercial |
$332.38
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Advantage |
$870.49
|
| Rate for Payer: Cofinity Commercial |
$1,069.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,119.20
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,057.03
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$783.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.31
|
| Rate for Payer: UHC Core |
$647.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$488.72
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$783.44 |
| Max. Negotiated Rate |
$1,119.20 |
| Rate for Payer: Aetna Commercial |
$1,057.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.31
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Advantage |
$870.49
|
| Rate for Payer: Cofinity Commercial |
$1,069.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Healthscope Commercial |
$1,119.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PHP Commercial |
$1,057.03
|
| Rate for Payer: Priority Health SBD |
$783.44
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$523.94
|
| Rate for Payer: BCN Commercial |
$523.94
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.79
|
| Rate for Payer: UHC Core |
$885.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$667.97
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,070.80 |
| Max. Negotiated Rate |
$1,529.71 |
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$687.12 |
| Max. Negotiated Rate |
$981.60 |
| Rate for Payer: Aetna Commercial |
$927.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.94
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Advantage |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$937.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Healthscope Commercial |
$981.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| Rate for Payer: PHP Commercial |
$927.07
|
| Rate for Payer: Priority Health SBD |
$687.12
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$927.07
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$414.15
|
| Rate for Payer: BCN Commercial |
$414.15
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Advantage |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$937.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$981.60
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.07
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$927.07
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$687.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.94
|
| Rate for Payer: UHC Core |
$568.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$428.63
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna Commercial |
$1,681.87
|
| Rate for Payer: Aetna Medicare |
$241.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$185.50
|
| Rate for Payer: BCN Commercial |
$185.50
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Advantage |
$1,385.07
|
| Rate for Payer: Cofinity Commercial |
$1,701.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$1,780.80
|
| Rate for Payer: Mclaren Medicaid |
$121.60
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.87
|
| Rate for Payer: Nomi Health Commercial |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$1,681.87
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.88
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health SBD |
$1,246.56
|
| Rate for Payer: Priority Health Tiered Network |
$601.50
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,286.14
|
| Rate for Payer: UHC Core |
$1,030.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$777.62
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,246.56 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna Commercial |
$1,681.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.14
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Advantage |
$1,385.07
|
| Rate for Payer: Cofinity Commercial |
$1,701.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Healthscope Commercial |
$1,780.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| Rate for Payer: PHP Commercial |
$1,681.87
|
| Rate for Payer: Priority Health SBD |
$1,246.56
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Advantage |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.41
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Advantage |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.66
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$75.69
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$90.29
|
| Rate for Payer: BCN Commercial |
$90.29
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$75.69
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$56.10
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.88
|
| Rate for Payer: UHC Core |
$58.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$58.88
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$80.14 |
| Rate for Payer: Aetna Commercial |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.88
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PHP Commercial |
$75.69
|
| Rate for Payer: Priority Health SBD |
$56.10
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,587.05 |
| Max. Negotiated Rate |
$2,267.22 |
| Rate for Payer: Aetna Commercial |
$2,141.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,637.43
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Advantage |
$1,763.39
|
| Rate for Payer: Cofinity Commercial |
$2,166.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Healthscope Commercial |
$2,267.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: PHP Commercial |
$2,141.26
|
| Rate for Payer: Priority Health SBD |
$1,587.05
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$362.72 |
| Max. Negotiated Rate |
$3,923.26 |
| Rate for Payer: Aetna Commercial |
$2,141.26
|
| Rate for Payer: Aetna Medicare |
$1,261.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,637.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,516.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,516.45
|
| Rate for Payer: BCBS Complete |
$666.27
|
| Rate for Payer: BCBS MAPPO |
$1,213.16
|
| Rate for Payer: BCBS Trust/PPO |
$362.72
|
| Rate for Payer: BCN Commercial |
$362.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,213.16
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Advantage |
$1,763.39
|
| Rate for Payer: Cofinity Commercial |
$2,166.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,213.16
|
| Rate for Payer: Healthscope Commercial |
$2,267.22
|
| Rate for Payer: Mclaren Medicaid |
$634.48
|
| Rate for Payer: Mclaren Medicare |
$1,213.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.82
|
| Rate for Payer: Meridian Medicaid |
$1,273.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,395.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Nomi Health Commercial |
$3,639.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: PACE Medicare |
$1,152.50
|
| Rate for Payer: PACE SWMI |
$1,213.16
|
| Rate for Payer: PHP Commercial |
$2,141.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,213.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,923.26
|
| Rate for Payer: Priority Health Medicare |
$1,213.16
|
| Rate for Payer: Priority Health SBD |
$1,587.05
|
| Rate for Payer: Priority Health Tiered Network |
$3,138.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,213.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,213.16
|
| Rate for Payer: UHC Medicaid |
$634.48
|
| Rate for Payer: UHCCP Medicaid |
$634.48
|
| Rate for Payer: VA VA |
$1,213.16
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$454.04 |
| Max. Negotiated Rate |
$1,039.79 |
| Rate for Payer: Aetna Commercial |
$982.02
|
| Rate for Payer: Aetna Medicare |
$577.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.96
|
| Rate for Payer: BCBS Complete |
$462.13
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Advantage |
$808.72
|
| Rate for Payer: Cofinity Commercial |
$993.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,039.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$924.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: PHP Commercial |
$982.02
|
| Rate for Payer: Priority Health SBD |
$727.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.96
|
| Rate for Payer: UHC Core |
$601.92
|
| Rate for Payer: UHC Exchange |
$454.04
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$727.85 |
| Max. Negotiated Rate |
$1,039.79 |
| Rate for Payer: Aetna Commercial |
$982.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.96
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Advantage |
$808.72
|
| Rate for Payer: Cofinity Commercial |
$993.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,039.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: PHP Commercial |
$982.02
|
| Rate for Payer: Priority Health SBD |
$727.85
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.52 |
| Max. Negotiated Rate |
$848.52 |
| Rate for Payer: Aetna Commercial |
$801.38
|
| Rate for Payer: Aetna Medicare |
$471.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.82
|
| Rate for Payer: BCBS Complete |
$377.12
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Advantage |
$659.96
|
| Rate for Payer: Cofinity Commercial |
$810.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$848.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$754.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: PHP Commercial |
$801.38
|
| Rate for Payer: Priority Health SBD |
$593.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.82
|
| Rate for Payer: UHC Core |
$491.20
|
| Rate for Payer: UHC Exchange |
$370.52
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$593.96 |
| Max. Negotiated Rate |
$848.52 |
| Rate for Payer: Aetna Commercial |
$801.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.82
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Advantage |
$659.96
|
| Rate for Payer: Cofinity Commercial |
$810.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$848.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: PHP Commercial |
$801.38
|
| Rate for Payer: Priority Health SBD |
$593.96
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.66 |
| Max. Negotiated Rate |
$329.51 |
| Rate for Payer: Aetna Commercial |
$311.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.98
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Advantage |
$256.28
|
| Rate for Payer: Cofinity Commercial |
$314.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: PHP Commercial |
$311.20
|
| Rate for Payer: Priority Health SBD |
$230.66
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.42 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$311.20
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Advantage |
$256.28
|
| Rate for Payer: Cofinity Commercial |
$314.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$311.20
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$230.66
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.98
|
| Rate for Payer: UHC Core |
$190.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$143.89
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.74 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,429.15
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,622.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.74
|
| Rate for Payer: BCN Commercial |
$1,620.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Advantage |
$2,824.00
|
| Rate for Payer: Cofinity Commercial |
$3,469.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,630.86
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,429.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,541.60
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,541.60 |
| Max. Negotiated Rate |
$3,630.86 |
| Rate for Payer: Aetna Commercial |
$3,429.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,622.29
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Advantage |
$2,824.00
|
| Rate for Payer: Cofinity Commercial |
$3,469.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Healthscope Commercial |
$3,630.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PHP Commercial |
$3,429.15
|
| Rate for Payer: Priority Health SBD |
$2,541.60
|
|
