|
HC VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
IP
|
$2,394.47
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
32000320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,508.52 |
| Max. Negotiated Rate |
$2,155.02 |
| Rate for Payer: Aetna Commercial |
$2,035.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.41
|
| Rate for Payer: Cash Price |
$1,915.58
|
| Rate for Payer: Cofinity Commercial |
$2,059.24
|
| Rate for Payer: Cofinity Commercial |
$1,676.13
|
| Rate for Payer: Healthscope Commercial |
$2,155.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,035.30
|
| Rate for Payer: PHP Commercial |
$2,035.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.13
|
| Rate for Payer: Priority Health SBD |
$1,508.52
|
|
|
HC VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
OP
|
$2,394.47
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
32000320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,035.30
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.41
|
| 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 |
$162.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$1,915.58
|
| Rate for Payer: Cash Price |
$1,915.58
|
| Rate for Payer: Cofinity Commercial |
$1,676.13
|
| Rate for Payer: Cofinity Commercial |
$2,059.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$2,155.02
|
| 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 |
$2,035.30
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,035.30
|
| 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 |
$1,676.13
|
| 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 |
$1,508.52
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC VENOUS INSUFFICIENCY BIL
|
Facility
|
OP
|
$1,760.88
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92000033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,584.79 |
| Rate for Payer: Aetna Commercial |
$1,496.75
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.57
|
| 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 |
$1,408.70
|
| Rate for Payer: Cash Price |
$1,408.70
|
| Rate for Payer: Cofinity Commercial |
$1,232.62
|
| Rate for Payer: Cofinity Commercial |
$1,514.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,584.79
|
| 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 |
$1,496.75
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,496.75
|
| 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 |
$1,232.62
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$1,109.35
|
| 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 VENOUS INSUFFICIENCY BIL
|
Facility
|
IP
|
$1,760.88
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92000033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,109.35 |
| Max. Negotiated Rate |
$1,584.79 |
| Rate for Payer: Aetna Commercial |
$1,496.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.57
|
| Rate for Payer: Cash Price |
$1,408.70
|
| Rate for Payer: Cofinity Commercial |
$1,232.62
|
| Rate for Payer: Cofinity Commercial |
$1,514.36
|
| Rate for Payer: Healthscope Commercial |
$1,584.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,496.75
|
| Rate for Payer: PHP Commercial |
$1,496.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.62
|
| Rate for Payer: Priority Health SBD |
$1,109.35
|
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
IP
|
$4,553.46
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
36100372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,868.68 |
| Max. Negotiated Rate |
$4,098.11 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.75
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,187.42
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health SBD |
$2,868.68
|
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
OP
|
$4,553.46
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
36100372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.88 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.75
|
| 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 |
$1,107.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Cofinity Commercial |
$3,187.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| 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 |
$3,870.44
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| 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 |
$3,187.42
|
| 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 |
$2,868.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.07
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$321.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100010
|
|
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 VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100010
|
|
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 VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100028
|
|
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 VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100028
|
|
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 VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
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 VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
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 VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
IP
|
$1,000.73
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$630.46 |
| Max. Negotiated Rate |
$900.66 |
| Rate for Payer: Aetna Commercial |
$850.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.47
|
| Rate for Payer: Cash Price |
$800.58
|
| Rate for Payer: Cofinity Commercial |
$700.51
|
| Rate for Payer: Cofinity Commercial |
$860.63
|
| Rate for Payer: Healthscope Commercial |
$900.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.62
|
| Rate for Payer: PHP Commercial |
$850.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.51
|
| Rate for Payer: Priority Health SBD |
$630.46
|
|
|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
OP
|
$1,000.73
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$900.66 |
| Rate for Payer: Aetna Commercial |
$850.62
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.47
|
| 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 |
$800.58
|
| Rate for Payer: Cash Price |
$800.58
|
| Rate for Payer: Cofinity Commercial |
$700.51
|
| Rate for Payer: Cofinity Commercial |
$860.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$900.66
|
| 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 |
$850.62
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$850.62
|
| 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 |
$700.51
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$630.46
|
| 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 VENT CPS Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC VENT CPS Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
IP
|
$7,963.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,016.69 |
| Max. Negotiated Rate |
$7,166.70 |
| Rate for Payer: Aetna Commercial |
$6,768.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,175.95
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cofinity Commercial |
$5,574.10
|
| Rate for Payer: Cofinity Commercial |
$6,848.18
|
| Rate for Payer: Healthscope Commercial |
$7,166.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,768.55
|
| Rate for Payer: PHP Commercial |
$6,768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,574.10
|
| Rate for Payer: Priority Health SBD |
$5,016.69
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
OP
|
$7,963.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.59 |
| Max. Negotiated Rate |
$7,166.70 |
| Rate for Payer: Aetna Commercial |
$6,768.55
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,175.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,778.43
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cofinity Commercial |
$6,848.18
|
| Rate for Payer: Cofinity Commercial |
$5,574.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$7,166.70
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,768.55
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$6,768.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,574.10
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health SBD |
$5,016.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$59.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
OP
|
$841.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$757.36 |
| Rate for Payer: Aetna Commercial |
$715.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.98
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: Cash Price |
$673.21
|
| Rate for Payer: Cofinity Commercial |
$589.06
|
| Rate for Payer: Cofinity Commercial |
$723.70
|
| Rate for Payer: Healthscope Commercial |
$757.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.28
|
| Rate for Payer: PHP Commercial |
$715.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.06
|
| Rate for Payer: Priority Health SBD |
$530.15
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
IP
|
$841.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$530.15 |
| Max. Negotiated Rate |
$757.36 |
| Rate for Payer: Aetna Commercial |
$715.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.98
|
| Rate for Payer: Cash Price |
$673.21
|
| Rate for Payer: Cofinity Commercial |
$589.06
|
| Rate for Payer: Cofinity Commercial |
$723.70
|
| Rate for Payer: Healthscope Commercial |
$757.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.28
|
| Rate for Payer: PHP Commercial |
$715.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.06
|
| Rate for Payer: Priority Health SBD |
$530.15
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
OP
|
$5,002.91
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.11 |
| Max. Negotiated Rate |
$8,817.68 |
| Rate for Payer: Aetna Commercial |
$4,252.47
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,251.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,282.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cofinity Commercial |
$4,302.50
|
| Rate for Payer: Cofinity Commercial |
$3,502.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$4,502.62
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,252.47
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$4,252.47
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,502.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
| Rate for Payer: Priority Health SBD |
$3,151.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.12
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$420.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
IP
|
$5,002.91
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.83 |
| Max. Negotiated Rate |
$4,502.62 |
| Rate for Payer: Aetna Commercial |
$4,252.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,251.89
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cofinity Commercial |
$3,502.04
|
| Rate for Payer: Cofinity Commercial |
$4,302.50
|
| Rate for Payer: Healthscope Commercial |
$4,502.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,252.47
|
| Rate for Payer: PHP Commercial |
$4,252.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,502.04
|
| Rate for Payer: Priority Health SBD |
$3,151.83
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
OP
|
$5,349.22
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$4,814.30 |
| Rate for Payer: Aetna Commercial |
$4,546.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,476.99
|
| Rate for Payer: BCBS Complete |
$2,139.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,196.83
|
| Rate for Payer: Cash Price |
$4,279.38
|
| Rate for Payer: Cash Price |
$4,279.38
|
| Rate for Payer: Cofinity Commercial |
$3,744.45
|
| Rate for Payer: Cofinity Commercial |
$4,600.33
|
| Rate for Payer: Healthscope Commercial |
$4,814.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,546.84
|
| Rate for Payer: PHP Commercial |
$4,546.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,744.45
|
| Rate for Payer: Priority Health SBD |
$3,370.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.79
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$200.72
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
IP
|
$5,349.22
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,370.01 |
| Max. Negotiated Rate |
$4,814.30 |
| Rate for Payer: Aetna Commercial |
$4,546.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,476.99
|
| Rate for Payer: Cash Price |
$4,279.38
|
| Rate for Payer: Cofinity Commercial |
$3,744.45
|
| Rate for Payer: Cofinity Commercial |
$4,600.33
|
| Rate for Payer: Healthscope Commercial |
$4,814.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,546.84
|
| Rate for Payer: PHP Commercial |
$4,546.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,744.45
|
| Rate for Payer: Priority Health SBD |
$3,370.01
|
|
|
HC VERPLSTY W WO BONE BX L S 1ST
|
Facility
|
IP
|
$4,321.70
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
36100464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,722.67 |
| Max. Negotiated Rate |
$3,889.53 |
| Rate for Payer: Aetna Commercial |
$3,673.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,809.10
|
| Rate for Payer: Cash Price |
$3,457.36
|
| Rate for Payer: Cofinity Commercial |
$3,025.19
|
| Rate for Payer: Cofinity Commercial |
$3,716.66
|
| Rate for Payer: Healthscope Commercial |
$3,889.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,673.44
|
| Rate for Payer: PHP Commercial |
$3,673.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.19
|
| Rate for Payer: Priority Health SBD |
$2,722.67
|
|
