|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
OP
|
$1,072.90
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$965.61 |
| Rate for Payer: Aetna Commercial |
$911.97
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$858.32
|
| Rate for Payer: Cash Price |
$858.32
|
| Rate for Payer: Cofinity Commercial |
$922.69
|
| Rate for Payer: Cofinity Commercial |
$751.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$751.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$965.61
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.97
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$911.97
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.38
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$675.93
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$793.95
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
OP
|
$1,959.46
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,763.51 |
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$1,234.46
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$1,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
IP
|
$1,959.46
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,234.46 |
| Max. Negotiated Rate |
$1,763.51 |
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.65
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health SBD |
$1,234.46
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
IP
|
$4,552.18
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,867.87 |
| Max. Negotiated Rate |
$4,096.96 |
| Rate for Payer: Aetna Commercial |
$3,869.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,958.92
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cofinity Commercial |
$3,186.53
|
| Rate for Payer: Cofinity Commercial |
$3,914.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,186.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,641.74
|
| Rate for Payer: Healthscope Commercial |
$4,096.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,869.35
|
| Rate for Payer: PHP Commercial |
$3,869.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,958.92
|
| Rate for Payer: Priority Health SBD |
$2,867.87
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
OP
|
$4,552.18
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$4,096.96 |
| Rate for Payer: Aetna Commercial |
$3,869.35
|
| Rate for Payer: Aetna Medicare |
$1,031.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,958.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cash Price |
$3,641.74
|
| Rate for Payer: Cofinity Commercial |
$3,914.87
|
| Rate for Payer: Cofinity Commercial |
$3,186.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,186.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,641.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$4,096.96
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,869.35
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$3,869.35
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,958.92
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health SBD |
$2,867.87
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$3,368.61
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$558.63
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
OP
|
$2,421.79
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,179.61 |
| Rate for Payer: Aetna Commercial |
$2,058.52
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,574.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cofinity Commercial |
$2,082.74
|
| Rate for Payer: Cofinity Commercial |
$1,695.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,179.61
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,058.52
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,058.52
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.16
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,525.73
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$1,792.12
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
IP
|
$2,421.79
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,525.73 |
| Max. Negotiated Rate |
$2,179.61 |
| Rate for Payer: Aetna Commercial |
$2,058.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,574.16
|
| Rate for Payer: Cash Price |
$1,937.43
|
| Rate for Payer: Cofinity Commercial |
$1,695.25
|
| Rate for Payer: Cofinity Commercial |
$2,082.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.43
|
| Rate for Payer: Healthscope Commercial |
$2,179.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,058.52
|
| Rate for Payer: PHP Commercial |
$2,058.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.16
|
| Rate for Payer: Priority Health SBD |
$1,525.73
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$887.47 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,197.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.65
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,211.47
|
| Rate for Payer: Cofinity Commercial |
$986.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$986.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: PHP Commercial |
$1,197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health SBD |
$887.47
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,197.39
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$986.08
|
| Rate for Payer: Cofinity Commercial |
$1,211.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$986.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,197.39
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$887.47
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,042.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,042.43
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$887.47 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,197.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.65
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,211.47
|
| Rate for Payer: Cofinity Commercial |
$986.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$986.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: PHP Commercial |
$1,197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health SBD |
$887.47
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,197.39
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$986.08
|
| Rate for Payer: Cofinity Commercial |
$1,211.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$986.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,197.39
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$887.47
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,042.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,042.43
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
OP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$780.87 |
| Rate for Payer: Aetna Commercial |
$737.49
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$746.16
|
| Rate for Payer: Cofinity Commercial |
$607.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$780.87
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.49
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$737.49
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.96
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$546.61
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$642.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$642.05
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
IP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$546.61 |
| Max. Negotiated Rate |
$780.87 |
| Rate for Payer: Aetna Commercial |
$737.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.96
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$607.34
|
| Rate for Payer: Cofinity Commercial |
$746.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Healthscope Commercial |
$780.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.49
|
| Rate for Payer: PHP Commercial |
$737.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.96
|
| Rate for Payer: Priority Health SBD |
$546.61
|
|
|
HC VEIN MAPPING UNILAT UPPER EXTREMITY (R OR L)
|
Facility
|
OP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$780.87 |
| Rate for Payer: Aetna Commercial |
$737.49
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$746.16
|
| Rate for Payer: Cofinity Commercial |
$607.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$780.87
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.49
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$737.49
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.96
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$546.61
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$642.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$642.05
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC VEIN MAPPING UNILAT UPPER EXTREMITY (R OR L)
|
Facility
|
IP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$546.61 |
| Max. Negotiated Rate |
$780.87 |
| Rate for Payer: Aetna Commercial |
$737.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.96
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$607.34
|
| Rate for Payer: Cofinity Commercial |
$746.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Healthscope Commercial |
$780.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.49
|
| Rate for Payer: PHP Commercial |
$737.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.96
|
| Rate for Payer: Priority Health SBD |
$546.61
|
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
IP
|
$2,412.96
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.16 |
| Max. Negotiated Rate |
$2,171.66 |
| Rate for Payer: Aetna Commercial |
$2,051.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.42
|
| Rate for Payer: Cash Price |
$1,930.37
|
| Rate for Payer: Cofinity Commercial |
$1,689.07
|
| Rate for Payer: Cofinity Commercial |
$2,075.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,689.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,930.37
|
| Rate for Payer: Healthscope Commercial |
$2,171.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,051.02
|
| Rate for Payer: PHP Commercial |
$2,051.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.42
|
| Rate for Payer: Priority Health SBD |
$1,520.16
|
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
OP
|
$2,412.96
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.18 |
| Max. Negotiated Rate |
$2,171.66 |
| Rate for Payer: Aetna Commercial |
$2,051.02
|
| Rate for Payer: Aetna Medicare |
$1,206.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.42
|
| Rate for Payer: BCBS Complete |
$965.18
|
| Rate for Payer: Cash Price |
$1,930.37
|
| Rate for Payer: Cofinity Commercial |
$1,689.07
|
| Rate for Payer: Cofinity Commercial |
$2,075.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,689.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,930.37
|
| Rate for Payer: Healthscope Commercial |
$2,171.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,051.02
|
| Rate for Payer: PHP Commercial |
$2,051.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.42
|
| Rate for Payer: Priority Health SBD |
$1,520.16
|
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
IP
|
$2,948.46
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,857.53 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna Commercial |
$2,506.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.50
|
| Rate for Payer: Cash Price |
$2,358.77
|
| Rate for Payer: Cofinity Commercial |
$2,063.92
|
| Rate for Payer: Cofinity Commercial |
$2,535.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.77
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.19
|
| Rate for Payer: PHP Commercial |
$2,506.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.50
|
| Rate for Payer: Priority Health SBD |
$1,857.53
|
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
OP
|
$2,948.46
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.38 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna Commercial |
$2,506.19
|
| Rate for Payer: Aetna Medicare |
$1,474.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.50
|
| Rate for Payer: BCBS Complete |
$1,179.38
|
| Rate for Payer: Cash Price |
$2,358.77
|
| Rate for Payer: Cofinity Commercial |
$2,063.92
|
| Rate for Payer: Cofinity Commercial |
$2,535.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.77
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.19
|
| Rate for Payer: PHP Commercial |
$2,506.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.50
|
| Rate for Payer: Priority Health SBD |
$1,857.53
|
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
IP
|
$408.07
|
|
| Hospital Charge Code |
36000051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.08 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$346.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.25
|
| Rate for Payer: Cash Price |
$326.46
|
| Rate for Payer: Cofinity Commercial |
$285.65
|
| Rate for Payer: Cofinity Commercial |
$350.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.46
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.86
|
| Rate for Payer: PHP Commercial |
$346.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.25
|
| Rate for Payer: Priority Health SBD |
$257.08
|
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
OP
|
$408.07
|
|
| Hospital Charge Code |
36000051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.23 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$346.86
|
| Rate for Payer: Aetna Medicare |
$204.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.25
|
| Rate for Payer: BCBS Complete |
$163.23
|
| Rate for Payer: Cash Price |
$326.46
|
| Rate for Payer: Cofinity Commercial |
$285.65
|
| Rate for Payer: Cofinity Commercial |
$350.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.46
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.86
|
| Rate for Payer: PHP Commercial |
$346.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.25
|
| Rate for Payer: Priority Health SBD |
$257.08
|
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
45000105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
45000105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC VENOGRAM ADRENAL
|
Facility
|
OP
|
$8,817.94
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
32000334
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$7,495.25
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,731.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$7,054.35
|
| Rate for Payer: Cash Price |
$7,054.35
|
| Rate for Payer: Cofinity Commercial |
$7,583.43
|
| Rate for Payer: Cofinity Commercial |
$6,172.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,054.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$7,936.15
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,495.25
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$7,495.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,731.66
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$5,555.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Core |
$6,525.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$6,525.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC VENOGRAM ADRENAL
|
Facility
|
IP
|
$8,817.94
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
32000334
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,555.30 |
| Max. Negotiated Rate |
$7,936.15 |
| Rate for Payer: Aetna Commercial |
$7,495.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,731.66
|
| Rate for Payer: Cash Price |
$7,054.35
|
| Rate for Payer: Cofinity Commercial |
$6,172.56
|
| Rate for Payer: Cofinity Commercial |
$7,583.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,054.35
|
| Rate for Payer: Healthscope Commercial |
$7,936.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,495.25
|
| Rate for Payer: PHP Commercial |
$7,495.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,731.66
|
| Rate for Payer: Priority Health SBD |
$5,555.30
|
|
