|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: ASR ASR |
$242.11
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$193.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$234.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$242.11
|
| Rate for Payer: Mclaren Commercial |
$224.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.14
|
| Rate for Payer: Priority Health Narrow Network |
$177.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.65
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Aetna Commercial |
$253.12
|
| Rate for Payer: ASR ASR |
$272.81
|
| Rate for Payer: BCBS Trust/PPO |
$218.05
|
| Rate for Payer: BCN Commercial |
$218.05
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$264.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$281.25
|
| Rate for Payer: Healthscope Whirlpool |
$272.81
|
| Rate for Payer: Mclaren Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.50
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Aetna Commercial |
$253.12
|
| Rate for Payer: ASR ASR |
$272.81
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$218.05
|
| Rate for Payer: BCN Commercial |
$218.05
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$264.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$281.25
|
| Rate for Payer: Healthscope Whirlpool |
$272.81
|
| Rate for Payer: Mclaren Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.94
|
| Rate for Payer: Priority Health Narrow Network |
$199.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.50
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$411.39 |
| Rate for Payer: Aetna Commercial |
$370.25
|
| Rate for Payer: ASR ASR |
$399.05
|
| Rate for Payer: BCBS Trust/PPO |
$318.95
|
| Rate for Payer: BCN Commercial |
$318.95
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$386.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Healthscope Commercial |
$411.39
|
| Rate for Payer: Healthscope Whirlpool |
$399.05
|
| Rate for Payer: Mclaren Commercial |
$370.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.02
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.56 |
| Max. Negotiated Rate |
$411.39 |
| Rate for Payer: Aetna Commercial |
$370.25
|
| Rate for Payer: ASR ASR |
$399.05
|
| Rate for Payer: BCBS Complete |
$164.56
|
| Rate for Payer: BCBS Trust/PPO |
$318.95
|
| Rate for Payer: BCN Commercial |
$318.95
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$386.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Healthscope Commercial |
$411.39
|
| Rate for Payer: Healthscope Whirlpool |
$399.05
|
| Rate for Payer: Mclaren Commercial |
$370.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.36
|
| Rate for Payer: Priority Health Narrow Network |
$292.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.02
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.34 |
| Max. Negotiated Rate |
$528.36 |
| Rate for Payer: Aetna Commercial |
$475.52
|
| Rate for Payer: ASR ASR |
$512.51
|
| Rate for Payer: BCBS Complete |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$409.64
|
| Rate for Payer: BCN Commercial |
$409.64
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$496.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Healthscope Commercial |
$528.36
|
| Rate for Payer: Healthscope Whirlpool |
$512.51
|
| Rate for Payer: Mclaren Commercial |
$475.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.81
|
| Rate for Payer: Priority Health Narrow Network |
$375.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.96
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.85 |
| Max. Negotiated Rate |
$528.36 |
| Rate for Payer: Aetna Commercial |
$475.52
|
| Rate for Payer: ASR ASR |
$512.51
|
| Rate for Payer: BCBS Trust/PPO |
$409.64
|
| Rate for Payer: BCN Commercial |
$409.64
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$496.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Healthscope Commercial |
$528.36
|
| Rate for Payer: Healthscope Whirlpool |
$512.51
|
| Rate for Payer: Mclaren Commercial |
$475.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.96
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.54 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Trust/PPO |
$52.66
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$67.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.88
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Complete |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$52.66
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$67.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.88
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.81
|
| Rate for Payer: Priority Health Narrow Network |
$48.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,625.00
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Aetna Commercial |
$10,462.50
|
| Rate for Payer: ASR ASR |
$11,276.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.86
|
| Rate for Payer: BCN Commercial |
$9,012.86
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$10,927.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$11,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,276.25
|
| Rate for Payer: Mclaren Commercial |
$10,462.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,230.00
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,625.00
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Aetna Commercial |
$10,462.50
|
| Rate for Payer: ASR ASR |
$11,276.25
|
| Rate for Payer: BCBS Complete |
$4,650.00
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.86
|
| Rate for Payer: BCN Commercial |
$9,012.86
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$10,927.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$11,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,276.25
|
| Rate for Payer: Mclaren Commercial |
$10,462.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,578.75
|
| Rate for Payer: Priority Health Narrow Network |
$8,253.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,230.00
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,545.11
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,881.58 |
| Max. Negotiated Rate |
$5,545.11 |
| Rate for Payer: Aetna Commercial |
$4,990.60
|
| Rate for Payer: ASR ASR |
$5,378.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,299.12
|
| Rate for Payer: BCN Commercial |
$4,299.12
|
| Rate for Payer: Cash Price |
$4,436.09
|
| Rate for Payer: Cofinity Commercial |
$5,212.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.09
|
| Rate for Payer: Healthscope Commercial |
$5,545.11
|
| Rate for Payer: Healthscope Whirlpool |
$5,378.76
|
| Rate for Payer: Mclaren Commercial |
$4,990.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,713.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,881.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,879.70
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,545.11
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.04 |
| Max. Negotiated Rate |
$5,545.11 |
| Rate for Payer: Aetna Commercial |
$4,990.60
|
| Rate for Payer: ASR ASR |
$5,378.76
|
| Rate for Payer: BCBS Complete |
$2,218.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,299.12
|
| Rate for Payer: BCN Commercial |
$4,299.12
|
| Rate for Payer: Cash Price |
$4,436.09
|
| Rate for Payer: Cofinity Commercial |
$5,212.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.09
|
| Rate for Payer: Healthscope Commercial |
$5,545.11
|
| Rate for Payer: Healthscope Whirlpool |
$5,378.76
|
| Rate for Payer: Mclaren Commercial |
$4,990.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,713.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,881.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,046.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,937.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,879.70
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,836.46 |
| Rate for Payer: Aetna Commercial |
$1,652.81
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,781.37
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,423.81
|
| Rate for Payer: BCN Commercial |
$1,423.81
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,726.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,469.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,836.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,781.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,652.81
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,671.18
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,616.08
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,285.52 |
| Max. Negotiated Rate |
$1,836.46 |
| Rate for Payer: Aetna Commercial |
$1,652.81
|
| Rate for Payer: ASR ASR |
$1,781.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,423.81
|
| Rate for Payer: BCN Commercial |
$1,423.81
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,726.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,469.17
|
| Rate for Payer: Healthscope Commercial |
$1,836.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,781.37
|
| Rate for Payer: Mclaren Commercial |
$1,652.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,616.08
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$779.90 |
| Rate for Payer: Aetna Commercial |
$701.91
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$756.50
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$604.66
|
| Rate for Payer: BCN Commercial |
$604.66
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$733.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$623.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$779.90
|
| Rate for Payer: Healthscope Whirlpool |
$756.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$701.91
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.71
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$553.73
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.31
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$545.93 |
| Max. Negotiated Rate |
$779.90 |
| Rate for Payer: Aetna Commercial |
$701.91
|
| Rate for Payer: ASR ASR |
$756.50
|
| Rate for Payer: BCBS Trust/PPO |
$604.66
|
| Rate for Payer: BCN Commercial |
$604.66
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$733.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$623.92
|
| Rate for Payer: Healthscope Commercial |
$779.90
|
| Rate for Payer: Healthscope Whirlpool |
$756.50
|
| Rate for Payer: Mclaren Commercial |
$701.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.31
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,290.11 |
| Max. Negotiated Rate |
$16,128.73 |
| Rate for Payer: Aetna Commercial |
$14,515.86
|
| Rate for Payer: ASR ASR |
$15,644.87
|
| Rate for Payer: BCBS Trust/PPO |
$12,504.60
|
| Rate for Payer: BCN Commercial |
$12,504.60
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$15,161.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,902.98
|
| Rate for Payer: Healthscope Commercial |
$16,128.73
|
| Rate for Payer: Healthscope Whirlpool |
$15,644.87
|
| Rate for Payer: Mclaren Commercial |
$14,515.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,193.28
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$16,128.73 |
| Rate for Payer: Aetna Commercial |
$14,515.86
|
| Rate for Payer: Aetna Medicare |
$9,778.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: ASR ASR |
$15,644.87
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$12,504.60
|
| Rate for Payer: BCN Commercial |
$12,504.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$15,161.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,902.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$16,128.73
|
| Rate for Payer: Healthscope Whirlpool |
$15,644.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$14,515.86
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$10,756.56
|
| Rate for Payer: PHP Medicaid |
$5,348.94
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,461.65
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$7,569.32
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,193.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,618.08 |
| Max. Negotiated Rate |
$18,025.83 |
| Rate for Payer: Aetna Commercial |
$16,223.25
|
| Rate for Payer: ASR ASR |
$17,485.06
|
| Rate for Payer: BCBS Trust/PPO |
$13,975.43
|
| Rate for Payer: BCN Commercial |
$13,975.43
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$16,944.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,420.66
|
| Rate for Payer: Healthscope Commercial |
$18,025.83
|
| Rate for Payer: Healthscope Whirlpool |
$17,485.06
|
| Rate for Payer: Mclaren Commercial |
$16,223.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,862.73
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,569.32 |
| Max. Negotiated Rate |
$19,483.22 |
| Rate for Payer: Aetna Commercial |
$16,223.25
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$17,485.06
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$13,975.43
|
| Rate for Payer: BCN Commercial |
$13,975.43
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$16,944.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,420.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$18,025.83
|
| Rate for Payer: Healthscope Whirlpool |
$17,485.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$16,223.25
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,461.65
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$7,569.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,862.73
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,235.38 |
| Max. Negotiated Rate |
$7,479.11 |
| Rate for Payer: Aetna Commercial |
$6,731.20
|
| Rate for Payer: ASR ASR |
$7,254.74
|
| Rate for Payer: BCBS Trust/PPO |
$5,798.55
|
| Rate for Payer: BCN Commercial |
$5,798.55
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$7,030.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.29
|
| Rate for Payer: Healthscope Commercial |
$7,479.11
|
| Rate for Payer: Healthscope Whirlpool |
$7,254.74
|
| Rate for Payer: Mclaren Commercial |
$6,731.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,581.62
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,991.64 |
| Max. Negotiated Rate |
$7,479.11 |
| Rate for Payer: Aetna Commercial |
$6,731.20
|
| Rate for Payer: ASR ASR |
$7,254.74
|
| Rate for Payer: BCBS Complete |
$2,991.64
|
| Rate for Payer: BCBS Trust/PPO |
$5,798.55
|
| Rate for Payer: BCN Commercial |
$5,798.55
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$7,030.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.29
|
| Rate for Payer: Healthscope Commercial |
$7,479.11
|
| Rate for Payer: Healthscope Whirlpool |
$7,254.74
|
| Rate for Payer: Mclaren Commercial |
$6,731.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,805.99
|
| Rate for Payer: Priority Health Narrow Network |
$5,310.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,581.62
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna Commercial |
$1,653.75
|
| Rate for Payer: ASR ASR |
$1,782.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,424.61
|
| Rate for Payer: BCN Commercial |
$1,424.61
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cofinity Commercial |
$1,727.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,470.00
|
| Rate for Payer: Healthscope Commercial |
$1,837.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,782.38
|
| Rate for Payer: Mclaren Commercial |
$1,653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,561.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,617.00
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
OP
|
$1,837.50
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna Commercial |
$1,653.75
|
| Rate for Payer: ASR ASR |
$1,782.38
|
| Rate for Payer: BCBS Complete |
$735.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,424.61
|
| Rate for Payer: BCN Commercial |
$1,424.61
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cofinity Commercial |
$1,727.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,470.00
|
| Rate for Payer: Healthscope Commercial |
$1,837.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,782.38
|
| Rate for Payer: Mclaren Commercial |
$1,653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,561.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,672.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,304.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,617.00
|
|
