|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: ASR ASR |
$152.78
|
| Rate for Payer: BCBS Trust/PPO |
$122.11
|
| Rate for Payer: BCN Commercial |
$122.11
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Whirlpool |
$152.78
|
| Rate for Payer: Mclaren Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.60
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: ASR ASR |
$152.78
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$122.11
|
| Rate for Payer: BCN Commercial |
$122.11
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Whirlpool |
$152.78
|
| Rate for Payer: Mclaren Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.32
|
| Rate for Payer: Priority Health Narrow Network |
$111.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.60
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
IP
|
$472.50
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$425.25
|
| Rate for Payer: ASR ASR |
$458.32
|
| Rate for Payer: BCBS Trust/PPO |
$366.33
|
| Rate for Payer: BCN Commercial |
$366.33
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cofinity Commercial |
$444.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.00
|
| Rate for Payer: Healthscope Commercial |
$472.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.32
|
| Rate for Payer: Mclaren Commercial |
$425.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.80
|
|
|
HC EMBOLIZATION COILS LVL2
|
Facility
|
OP
|
$472.50
|
|
| Hospital Charge Code |
27800092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$425.25
|
| Rate for Payer: ASR ASR |
$458.32
|
| Rate for Payer: BCBS Complete |
$189.00
|
| Rate for Payer: BCBS Trust/PPO |
$366.33
|
| Rate for Payer: BCN Commercial |
$366.33
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cofinity Commercial |
$444.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.00
|
| Rate for Payer: Healthscope Commercial |
$472.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.32
|
| Rate for Payer: Mclaren Commercial |
$425.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.98
|
| Rate for Payer: Priority Health Narrow Network |
$335.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.80
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
OP
|
$2,320.50
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.20 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Aetna Commercial |
$2,088.45
|
| Rate for Payer: ASR ASR |
$2,250.88
|
| Rate for Payer: BCBS Complete |
$928.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.08
|
| Rate for Payer: BCN Commercial |
$1,799.08
|
| Rate for Payer: Cash Price |
$1,856.40
|
| Rate for Payer: Cofinity Commercial |
$2,181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,856.40
|
| Rate for Payer: Healthscope Commercial |
$2,320.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,250.88
|
| Rate for Payer: Mclaren Commercial |
$2,088.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,972.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,111.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,647.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,042.04
|
|
|
HC EMBOLIZATION COILS LVL 9
|
Facility
|
IP
|
$2,320.50
|
|
| Hospital Charge Code |
27800046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.35 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Aetna Commercial |
$2,088.45
|
| Rate for Payer: ASR ASR |
$2,250.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.08
|
| Rate for Payer: BCN Commercial |
$1,799.08
|
| Rate for Payer: Cash Price |
$1,856.40
|
| Rate for Payer: Cofinity Commercial |
$2,181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,856.40
|
| Rate for Payer: Healthscope Commercial |
$2,320.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,250.88
|
| Rate for Payer: Mclaren Commercial |
$2,088.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,972.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,042.04
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
OP
|
$16,922.27
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$16,922.27 |
| Rate for Payer: Aetna Commercial |
$15,230.04
|
| 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 |
$16,414.60
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,119.84
|
| Rate for Payer: BCN Commercial |
$13,119.84
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cofinity Commercial |
$15,906.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,537.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$16,922.27
|
| Rate for Payer: Healthscope Whirlpool |
$16,414.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$15,230.04
|
| 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 |
$14,383.93
|
| 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 |
$11,845.59
|
| 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 |
$14,891.60
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC EMBOLIZATION FOR TUMORS ORGANS OR INFARCTION
|
Facility
|
IP
|
$16,922.27
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
36100430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,845.59 |
| Max. Negotiated Rate |
$16,922.27 |
| Rate for Payer: Aetna Commercial |
$15,230.04
|
| Rate for Payer: ASR ASR |
$16,414.60
|
| Rate for Payer: BCBS Trust/PPO |
$13,119.84
|
| Rate for Payer: BCN Commercial |
$13,119.84
|
| Rate for Payer: Cash Price |
$13,537.82
|
| Rate for Payer: Cofinity Commercial |
$15,906.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,537.82
|
| Rate for Payer: Healthscope Commercial |
$16,922.27
|
| Rate for Payer: Healthscope Whirlpool |
$16,414.60
|
| Rate for Payer: Mclaren Commercial |
$15,230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,383.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,845.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,891.60
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
IP
|
$5,151.29
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,605.90 |
| Max. Negotiated Rate |
$5,151.29 |
| Rate for Payer: Aetna Commercial |
$4,636.16
|
| Rate for Payer: ASR ASR |
$4,996.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,993.80
|
| Rate for Payer: BCN Commercial |
$3,993.80
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cofinity Commercial |
$4,842.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.03
|
| Rate for Payer: Healthscope Commercial |
$5,151.29
|
| Rate for Payer: Healthscope Whirlpool |
$4,996.75
|
| Rate for Payer: Mclaren Commercial |
$4,636.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,378.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,605.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,533.14
|
|
|
HC EMBOLIZATION NON-CNS HEAD OR NECK
|
Facility
|
OP
|
$5,151.29
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,605.90 |
| Max. Negotiated Rate |
$12,223.36 |
| Rate for Payer: Aetna Commercial |
$4,636.16
|
| 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 |
$4,996.75
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,993.80
|
| Rate for Payer: BCN Commercial |
$3,993.80
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cash Price |
$4,121.03
|
| Rate for Payer: Cofinity Commercial |
$4,842.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$5,151.29
|
| Rate for Payer: Healthscope Whirlpool |
$4,996.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$4,636.16
|
| 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 |
$4,378.60
|
| 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 |
$3,605.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,687.67
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$3,657.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,533.14
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
IP
|
$420.35
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.24 |
| Max. Negotiated Rate |
$420.35 |
| Rate for Payer: Aetna Commercial |
$378.32
|
| Rate for Payer: ASR ASR |
$407.74
|
| Rate for Payer: BCBS Trust/PPO |
$325.90
|
| Rate for Payer: BCN Commercial |
$325.90
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cofinity Commercial |
$395.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.28
|
| Rate for Payer: Healthscope Commercial |
$420.35
|
| Rate for Payer: Healthscope Whirlpool |
$407.74
|
| Rate for Payer: Mclaren Commercial |
$378.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.91
|
|
|
HC EMBOLIZATION URETER
|
Facility
|
OP
|
$420.35
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
36100511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.14 |
| Max. Negotiated Rate |
$420.35 |
| Rate for Payer: Aetna Commercial |
$378.32
|
| Rate for Payer: ASR ASR |
$407.74
|
| Rate for Payer: BCBS Complete |
$168.14
|
| Rate for Payer: BCBS Trust/PPO |
$325.90
|
| Rate for Payer: BCN Commercial |
$325.90
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cofinity Commercial |
$395.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.28
|
| Rate for Payer: Healthscope Commercial |
$420.35
|
| Rate for Payer: Healthscope Whirlpool |
$407.74
|
| Rate for Payer: Mclaren Commercial |
$378.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.52
|
| Rate for Payer: Priority Health Narrow Network |
$298.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.91
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,025.83
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$18,025.83 |
| Rate for Payer: Aetna Commercial |
$16,223.25
|
| 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 |
$17,485.06
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,975.43
|
| Rate for Payer: BCN Commercial |
$13,975.43
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| 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 |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$18,025.83
|
| Rate for Payer: Healthscope Whirlpool |
$17,485.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$16,223.25
|
| 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 |
$15,321.96
|
| 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 |
$12,618.08
|
| 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 |
$15,862.73
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
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 EMBOSHIELD SYSTEM
|
Facility
|
OP
|
$5,786.68
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,314.67 |
| Max. Negotiated Rate |
$5,786.68 |
| Rate for Payer: Aetna Commercial |
$5,208.01
|
| Rate for Payer: ASR ASR |
$5,613.08
|
| Rate for Payer: BCBS Complete |
$2,314.67
|
| Rate for Payer: BCBS Trust/PPO |
$4,486.41
|
| Rate for Payer: BCN Commercial |
$4,486.41
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cofinity Commercial |
$5,439.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,629.34
|
| Rate for Payer: Healthscope Commercial |
$5,786.68
|
| Rate for Payer: Healthscope Whirlpool |
$5,613.08
|
| Rate for Payer: Mclaren Commercial |
$5,208.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,918.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,265.88
|
| Rate for Payer: Priority Health Narrow Network |
$4,108.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,092.28
|
|
|
HC EMBOSHIELD SYSTEM
|
Facility
|
IP
|
$5,786.68
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.68 |
| Max. Negotiated Rate |
$5,786.68 |
| Rate for Payer: Aetna Commercial |
$5,208.01
|
| Rate for Payer: ASR ASR |
$5,613.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,486.41
|
| Rate for Payer: BCN Commercial |
$4,486.41
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cofinity Commercial |
$5,439.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,629.34
|
| Rate for Payer: Healthscope Commercial |
$5,786.68
|
| Rate for Payer: Healthscope Whirlpool |
$5,613.08
|
| Rate for Payer: Mclaren Commercial |
$5,208.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,918.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,092.28
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$130.53
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Aetna Commercial |
$117.48
|
| Rate for Payer: ASR ASR |
$126.61
|
| Rate for Payer: BCBS Complete |
$52.21
|
| Rate for Payer: BCBS Trust/PPO |
$101.20
|
| Rate for Payer: BCN Commercial |
$101.20
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Commercial |
$122.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$130.53
|
| Rate for Payer: Healthscope Whirlpool |
$126.61
|
| Rate for Payer: Mclaren Commercial |
$117.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.87
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$130.53
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Aetna Commercial |
$117.48
|
| Rate for Payer: ASR ASR |
$126.61
|
| Rate for Payer: BCBS Trust/PPO |
$101.20
|
| Rate for Payer: BCN Commercial |
$101.20
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Commercial |
$122.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$130.53
|
| Rate for Payer: Healthscope Whirlpool |
$126.61
|
| Rate for Payer: Mclaren Commercial |
$117.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.87
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
IP
|
$344.16
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$240.91 |
| Max. Negotiated Rate |
$344.16 |
| Rate for Payer: Aetna Commercial |
$309.74
|
| Rate for Payer: ASR ASR |
$333.84
|
| Rate for Payer: BCBS Trust/PPO |
$266.83
|
| Rate for Payer: BCN Commercial |
$266.83
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cofinity Commercial |
$323.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.33
|
| Rate for Payer: Healthscope Commercial |
$344.16
|
| Rate for Payer: Healthscope Whirlpool |
$333.84
|
| Rate for Payer: Mclaren Commercial |
$309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.86
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
OP
|
$344.16
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$344.16 |
| Rate for Payer: Aetna Commercial |
$309.74
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$333.84
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$266.83
|
| Rate for Payer: BCN Commercial |
$266.83
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cofinity Commercial |
$323.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$344.16
|
| Rate for Payer: Healthscope Whirlpool |
$333.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$309.74
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.54
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.19
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$244.35
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.86
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC EMG BLADDER
|
Facility
|
OP
|
$357.96
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$357.96 |
| Rate for Payer: Aetna Commercial |
$322.16
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$347.22
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$277.53
|
| Rate for Payer: BCN Commercial |
$277.53
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cofinity Commercial |
$336.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$357.96
|
| Rate for Payer: Healthscope Whirlpool |
$347.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$322.16
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.27
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.74
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$254.15
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.00
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC EMG BLADDER
|
Facility
|
IP
|
$357.96
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$250.57 |
| Max. Negotiated Rate |
$357.96 |
| Rate for Payer: Aetna Commercial |
$322.16
|
| Rate for Payer: ASR ASR |
$347.22
|
| Rate for Payer: BCBS Trust/PPO |
$277.53
|
| Rate for Payer: BCN Commercial |
$277.53
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cofinity Commercial |
$336.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.37
|
| Rate for Payer: Healthscope Commercial |
$357.96
|
| Rate for Payer: Healthscope Whirlpool |
$347.22
|
| Rate for Payer: Mclaren Commercial |
$322.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.00
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
IP
|
$241.54
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$169.08 |
| Max. Negotiated Rate |
$241.54 |
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: ASR ASR |
$234.29
|
| Rate for Payer: BCBS Trust/PPO |
$187.27
|
| Rate for Payer: BCN Commercial |
$187.27
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$227.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.23
|
| Rate for Payer: Healthscope Commercial |
$241.54
|
| Rate for Payer: Healthscope Whirlpool |
$234.29
|
| Rate for Payer: Mclaren Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.56
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
OP
|
$241.54
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$241.54 |
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$234.29
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$187.27
|
| Rate for Payer: BCN Commercial |
$187.27
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$227.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$241.54
|
| Rate for Payer: Healthscope Whirlpool |
$234.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$217.39
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.31
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.80
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$171.49
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.56
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
OP
|
$600.05
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$600.05 |
| Rate for Payer: Aetna Commercial |
$540.04
|
| Rate for Payer: ASR ASR |
$582.05
|
| Rate for Payer: BCBS Complete |
$240.02
|
| Rate for Payer: BCBS Trust/PPO |
$465.22
|
| Rate for Payer: BCN Commercial |
$465.22
|
| Rate for Payer: Cash Price |
$480.04
|
| Rate for Payer: Cofinity Commercial |
$564.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.04
|
| Rate for Payer: Healthscope Commercial |
$600.05
|
| Rate for Payer: Healthscope Whirlpool |
$582.05
|
| Rate for Payer: Mclaren Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.05
|
| Rate for Payer: Priority Health Narrow Network |
$426.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.04
|
|
