|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
IP
|
$1,921.04
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,210.26 |
| Max. Negotiated Rate |
$1,728.94 |
| Rate for Payer: Aetna Commercial |
$1,632.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.68
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cofinity Commercial |
$1,344.73
|
| Rate for Payer: Cofinity Commercial |
$1,652.09
|
| Rate for Payer: Healthscope Commercial |
$1,728.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,632.88
|
| Rate for Payer: PHP Commercial |
$1,632.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.73
|
| Rate for Payer: Priority Health SBD |
$1,210.26
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
IP
|
$4,462.92
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,811.64 |
| Max. Negotiated Rate |
$4,016.63 |
| Rate for Payer: Aetna Commercial |
$3,793.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,900.90
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cofinity Commercial |
$3,124.04
|
| Rate for Payer: Cofinity Commercial |
$3,838.11
|
| Rate for Payer: Healthscope Commercial |
$4,016.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,793.48
|
| Rate for Payer: PHP Commercial |
$3,793.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,124.04
|
| Rate for Payer: Priority Health SBD |
$2,811.64
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
OP
|
$4,462.92
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$4,016.63 |
| Rate for Payer: Aetna Commercial |
$3,793.48
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,900.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,715.03
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cofinity Commercial |
$3,838.11
|
| Rate for Payer: Cofinity Commercial |
$3,124.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$4,016.63
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,793.48
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$3,793.48
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,124.04
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$2,811.64
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
IP
|
$2,374.30
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,495.81 |
| Max. Negotiated Rate |
$2,136.87 |
| Rate for Payer: Aetna Commercial |
$2,018.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.30
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cofinity Commercial |
$1,662.01
|
| Rate for Payer: Cofinity Commercial |
$2,041.90
|
| Rate for Payer: Healthscope Commercial |
$2,136.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,018.16
|
| Rate for Payer: PHP Commercial |
$2,018.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.01
|
| Rate for Payer: Priority Health SBD |
$1,495.81
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
OP
|
$2,374.30
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$2,136.87 |
| Rate for Payer: Aetna Commercial |
$2,018.16
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,404.70
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cofinity Commercial |
$2,041.90
|
| Rate for Payer: Cofinity Commercial |
$1,662.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,136.87
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,018.16
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$2,018.16
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.01
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,495.81
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$870.07 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.70
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Cofinity Commercial |
$966.75
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health SBD |
$870.07
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$716.89
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$966.75
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$870.07
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$716.89
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Cofinity Commercial |
$966.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$870.07
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$870.07 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.70
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Cofinity Commercial |
$966.75
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health SBD |
$870.07
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$535.89 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health SBD |
$535.89
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$452.85
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$535.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$116.90
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC VEIN MAPPING UNILAT UPPER EXTREMITY (R OR L)
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$535.89 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health SBD |
$535.89
|
|
|
HC VEIN MAPPING UNILAT UPPER EXTREMITY (R OR L)
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$452.85
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$535.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$116.90
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
OP
|
$2,365.65
|
|
|
Service Code
|
HCPCS c1880
|
| Hospital Charge Code |
27800093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.26 |
| Max. Negotiated Rate |
$2,129.08 |
| Rate for Payer: Aetna Commercial |
$2,010.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.67
|
| Rate for Payer: BCBS Complete |
$946.26
|
| Rate for Payer: Cash Price |
$1,892.52
|
| Rate for Payer: Cofinity Commercial |
$1,655.96
|
| Rate for Payer: Cofinity Commercial |
$2,034.46
|
| Rate for Payer: Healthscope Commercial |
$2,129.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,010.80
|
| Rate for Payer: PHP Commercial |
$2,010.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,655.96
|
| Rate for Payer: Priority Health SBD |
$1,490.36
|
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
IP
|
$2,365.65
|
|
|
Service Code
|
HCPCS c1880
|
| Hospital Charge Code |
27800093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.36 |
| Max. Negotiated Rate |
$2,129.08 |
| Rate for Payer: Aetna Commercial |
$2,010.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.67
|
| Rate for Payer: Cash Price |
$1,892.52
|
| Rate for Payer: Cofinity Commercial |
$1,655.96
|
| Rate for Payer: Cofinity Commercial |
$2,034.46
|
| Rate for Payer: Healthscope Commercial |
$2,129.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,010.80
|
| Rate for Payer: PHP Commercial |
$2,010.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,655.96
|
| Rate for Payer: Priority Health SBD |
$1,490.36
|
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
IP
|
$2,890.65
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.11 |
| Max. Negotiated Rate |
$2,601.58 |
| Rate for Payer: Aetna Commercial |
$2,457.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.92
|
| Rate for Payer: Cash Price |
$2,312.52
|
| Rate for Payer: Cofinity Commercial |
$2,023.46
|
| Rate for Payer: Cofinity Commercial |
$2,485.96
|
| Rate for Payer: Healthscope Commercial |
$2,601.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,457.05
|
| Rate for Payer: PHP Commercial |
$2,457.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,023.46
|
| Rate for Payer: Priority Health SBD |
$1,821.11
|
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
OP
|
$2,890.65
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.26 |
| Max. Negotiated Rate |
$2,601.58 |
| Rate for Payer: Aetna Commercial |
$2,457.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.92
|
| Rate for Payer: BCBS Complete |
$1,156.26
|
| Rate for Payer: Cash Price |
$2,312.52
|
| Rate for Payer: Cofinity Commercial |
$2,023.46
|
| Rate for Payer: Cofinity Commercial |
$2,485.96
|
| Rate for Payer: Healthscope Commercial |
$2,601.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,457.05
|
| Rate for Payer: PHP Commercial |
$2,457.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,023.46
|
| Rate for Payer: Priority Health SBD |
$1,821.11
|
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
IP
|
$400.07
|
|
| Hospital Charge Code |
36000051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.05
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$280.05
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
| Rate for Payer: Priority Health SBD |
$252.04
|
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
OP
|
$400.07
|
|
| Hospital Charge Code |
36000051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.03 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.05
|
| Rate for Payer: BCBS Complete |
$160.03
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$280.05
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
| Rate for Payer: Priority Health SBD |
$252.04
|
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
45000105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.72
|
| Rate for Payer: UHC Exchange |
$8.84
|
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
45000105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
|
|
HC VENOGRAM ADRENAL
|
Facility
|
IP
|
$8,645.04
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
32000334
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,446.38 |
| Max. Negotiated Rate |
$7,780.54 |
| Rate for Payer: Aetna Commercial |
$7,348.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,619.28
|
| Rate for Payer: Cash Price |
$6,916.03
|
| Rate for Payer: Cofinity Commercial |
$6,051.53
|
| Rate for Payer: Cofinity Commercial |
$7,434.73
|
| Rate for Payer: Healthscope Commercial |
$7,780.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,348.28
|
| Rate for Payer: PHP Commercial |
$7,348.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,051.53
|
| Rate for Payer: Priority Health SBD |
$5,446.38
|
|
|
HC VENOGRAM ADRENAL
|
Facility
|
OP
|
$8,645.04
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
32000334
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.67 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$7,348.28
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,619.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.67
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$6,916.03
|
| Rate for Payer: Cash Price |
$6,916.03
|
| Rate for Payer: Cofinity Commercial |
$7,434.73
|
| Rate for Payer: Cofinity Commercial |
$6,051.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$7,780.54
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,348.28
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$7,348.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,051.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$5,446.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$126.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC VENOGRAM INTERNAL JUGULAR
|
Facility
|
IP
|
$4,919.81
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
32000319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,099.48 |
| Max. Negotiated Rate |
$4,427.83 |
| Rate for Payer: Aetna Commercial |
$4,181.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,197.88
|
| Rate for Payer: Cash Price |
$3,935.85
|
| Rate for Payer: Cofinity Commercial |
$3,443.87
|
| Rate for Payer: Cofinity Commercial |
$4,231.04
|
| Rate for Payer: Healthscope Commercial |
$4,427.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,181.84
|
| Rate for Payer: PHP Commercial |
$4,181.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,443.87
|
| Rate for Payer: Priority Health SBD |
$3,099.48
|
|
|
HC VENOGRAM INTERNAL JUGULAR
|
Facility
|
OP
|
$4,919.81
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
32000319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$4,181.84
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,197.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$120.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,935.85
|
| Rate for Payer: Cash Price |
$3,935.85
|
| Rate for Payer: Cofinity Commercial |
$4,231.04
|
| Rate for Payer: Cofinity Commercial |
$3,443.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$4,427.83
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,181.84
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$4,181.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,443.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$3,099.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$123.12
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
