|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
OP
|
$2,871.60
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$938.78 |
| Max. Negotiated Rate |
$2,871.60 |
| Rate for Payer: Aetna Commercial |
$2,584.44
|
| Rate for Payer: Aetna Medicare |
$1,716.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: ASR ASR |
$2,785.45
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.35
|
| Rate for Payer: BCN Commercial |
$2,226.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cofinity Commercial |
$2,699.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,297.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$2,871.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,785.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$2,584.44
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,440.86
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$1,887.85
|
| Rate for Payer: PHP Medicaid |
$938.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.16
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,038.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,527.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
IP
|
$2,871.60
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,010.12 |
| Max. Negotiated Rate |
$2,871.60 |
| Rate for Payer: Aetna Commercial |
$2,584.44
|
| Rate for Payer: ASR ASR |
$2,785.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.35
|
| Rate for Payer: BCN Commercial |
$2,226.35
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cofinity Commercial |
$2,699.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,297.28
|
| Rate for Payer: Healthscope Commercial |
$2,871.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,785.45
|
| Rate for Payer: Mclaren Commercial |
$2,584.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,440.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,527.01
|
|
|
HC IR EMBOLIZATION
|
Facility
|
IP
|
$3,430.91
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,401.64 |
| Max. Negotiated Rate |
$3,430.91 |
| Rate for Payer: Aetna Commercial |
$3,087.82
|
| Rate for Payer: ASR ASR |
$3,327.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.98
|
| Rate for Payer: BCN Commercial |
$2,659.98
|
| Rate for Payer: Cash Price |
$2,744.73
|
| Rate for Payer: Cofinity Commercial |
$3,225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.73
|
| Rate for Payer: Healthscope Commercial |
$3,430.91
|
| Rate for Payer: Healthscope Whirlpool |
$3,327.98
|
| Rate for Payer: Mclaren Commercial |
$3,087.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,916.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,019.20
|
|
|
HC IR EMBOLIZATION
|
Facility
|
OP
|
$3,430.91
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,372.36 |
| Max. Negotiated Rate |
$3,430.91 |
| Rate for Payer: Aetna Commercial |
$3,087.82
|
| Rate for Payer: ASR ASR |
$3,327.98
|
| Rate for Payer: BCBS Complete |
$1,372.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.98
|
| Rate for Payer: BCN Commercial |
$2,659.98
|
| Rate for Payer: Cash Price |
$2,744.73
|
| Rate for Payer: Cofinity Commercial |
$3,225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.73
|
| Rate for Payer: Healthscope Commercial |
$3,430.91
|
| Rate for Payer: Healthscope Whirlpool |
$3,327.98
|
| Rate for Payer: Mclaren Commercial |
$3,087.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,916.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,122.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,435.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,019.20
|
|
|
HC IR ERCP
|
Facility
|
IP
|
$800.65
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$560.46 |
| Max. Negotiated Rate |
$800.65 |
| Rate for Payer: Aetna Commercial |
$720.58
|
| Rate for Payer: ASR ASR |
$776.63
|
| Rate for Payer: BCBS Trust/PPO |
$620.74
|
| Rate for Payer: BCN Commercial |
$620.74
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$752.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$800.65
|
| Rate for Payer: Healthscope Whirlpool |
$776.63
|
| Rate for Payer: Mclaren Commercial |
$720.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.57
|
|
|
HC IR ERCP
|
Facility
|
OP
|
$800.65
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$800.65 |
| Rate for Payer: Aetna Commercial |
$720.58
|
| Rate for Payer: ASR ASR |
$776.63
|
| Rate for Payer: BCBS Complete |
$320.26
|
| Rate for Payer: BCBS Trust/PPO |
$620.74
|
| Rate for Payer: BCN Commercial |
$620.74
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$752.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$800.65
|
| Rate for Payer: Healthscope Whirlpool |
$776.63
|
| Rate for Payer: Mclaren Commercial |
$720.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.59
|
| Rate for Payer: Priority Health Narrow Network |
$568.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.57
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
OP
|
$616.61
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.64 |
| Max. Negotiated Rate |
$616.61 |
| Rate for Payer: Aetna Commercial |
$554.95
|
| Rate for Payer: ASR ASR |
$598.11
|
| Rate for Payer: BCBS Complete |
$246.64
|
| Rate for Payer: BCBS Trust/PPO |
$478.06
|
| Rate for Payer: BCN Commercial |
$478.06
|
| Rate for Payer: Cash Price |
$493.29
|
| Rate for Payer: Cofinity Commercial |
$579.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.29
|
| Rate for Payer: Healthscope Commercial |
$616.61
|
| Rate for Payer: Healthscope Whirlpool |
$598.11
|
| Rate for Payer: Mclaren Commercial |
$554.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.12
|
| Rate for Payer: Priority Health Narrow Network |
$437.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.62
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
IP
|
$616.61
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.63 |
| Max. Negotiated Rate |
$616.61 |
| Rate for Payer: Aetna Commercial |
$554.95
|
| Rate for Payer: ASR ASR |
$598.11
|
| Rate for Payer: BCBS Trust/PPO |
$478.06
|
| Rate for Payer: BCN Commercial |
$478.06
|
| Rate for Payer: Cash Price |
$493.29
|
| Rate for Payer: Cofinity Commercial |
$579.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.29
|
| Rate for Payer: Healthscope Commercial |
$616.61
|
| Rate for Payer: Healthscope Whirlpool |
$598.11
|
| Rate for Payer: Mclaren Commercial |
$554.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.62
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Aetna Commercial |
$270.38
|
| Rate for Payer: ASR ASR |
$291.41
|
| Rate for Payer: BCBS Complete |
$120.17
|
| Rate for Payer: BCBS Trust/PPO |
$232.92
|
| Rate for Payer: BCN Commercial |
$232.92
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$282.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Healthscope Commercial |
$300.42
|
| Rate for Payer: Healthscope Whirlpool |
$291.41
|
| Rate for Payer: Mclaren Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.16
|
| Rate for Payer: Priority Health Narrow Network |
$177.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.37
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.29 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Aetna Commercial |
$270.38
|
| Rate for Payer: ASR ASR |
$291.41
|
| Rate for Payer: BCBS Trust/PPO |
$232.92
|
| Rate for Payer: BCN Commercial |
$232.92
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$282.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Healthscope Commercial |
$300.42
|
| Rate for Payer: Healthscope Whirlpool |
$291.41
|
| Rate for Payer: Mclaren Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.37
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Complete |
$220.23
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.66
|
| Rate for Payer: Priority Health Narrow Network |
$67.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.41 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.41 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.03
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$390.91
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$956.25
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Aetna Commercial |
$860.62
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$927.56
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$741.38
|
| Rate for Payer: BCN Commercial |
$741.38
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$898.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$956.25
|
| Rate for Payer: Healthscope Whirlpool |
$927.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$860.62
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$668.73
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$534.98
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.50
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$956.25
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.38 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Aetna Commercial |
$860.62
|
| Rate for Payer: ASR ASR |
$927.56
|
| Rate for Payer: BCBS Trust/PPO |
$741.38
|
| Rate for Payer: BCN Commercial |
$741.38
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$898.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.00
|
| Rate for Payer: Healthscope Commercial |
$956.25
|
| Rate for Payer: Healthscope Whirlpool |
$927.56
|
| Rate for Payer: Mclaren Commercial |
$860.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.50
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
OP
|
$1,477.35
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$1,477.35 |
| Rate for Payer: Aetna Commercial |
$1,329.62
|
| Rate for Payer: ASR ASR |
$1,433.03
|
| Rate for Payer: BCBS Complete |
$590.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.39
|
| Rate for Payer: BCN Commercial |
$1,145.39
|
| Rate for Payer: Cash Price |
$1,181.88
|
| Rate for Payer: Cofinity Commercial |
$1,388.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.88
|
| Rate for Payer: Healthscope Commercial |
$1,477.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,433.03
|
| Rate for Payer: Mclaren Commercial |
$1,329.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,048.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,300.07
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
IP
|
$1,477.35
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,034.14 |
| Max. Negotiated Rate |
$1,477.35 |
| Rate for Payer: Aetna Commercial |
$1,329.62
|
| Rate for Payer: ASR ASR |
$1,433.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.39
|
| Rate for Payer: BCN Commercial |
$1,145.39
|
| Rate for Payer: Cash Price |
$1,181.88
|
| Rate for Payer: Cofinity Commercial |
$1,388.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.88
|
| Rate for Payer: Healthscope Commercial |
$1,477.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,433.03
|
| Rate for Payer: Mclaren Commercial |
$1,329.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,300.07
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
IP
|
$2,162.34
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,513.64 |
| Max. Negotiated Rate |
$2,162.34 |
| Rate for Payer: Aetna Commercial |
$1,946.11
|
| Rate for Payer: ASR ASR |
$2,097.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.46
|
| Rate for Payer: BCN Commercial |
$1,676.46
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cofinity Commercial |
$2,032.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.87
|
| Rate for Payer: Healthscope Commercial |
$2,162.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.47
|
| Rate for Payer: Mclaren Commercial |
$1,946.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,902.86
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
OP
|
$2,162.34
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,162.34 |
| Rate for Payer: Aetna Commercial |
$1,946.11
|
| Rate for Payer: Aetna Medicare |
$805.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: ASR ASR |
$2,097.47
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.46
|
| Rate for Payer: BCN Commercial |
$1,676.46
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cofinity Commercial |
$2,032.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$2,162.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$1,946.11
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.99
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$886.32
|
| Rate for Payer: PHP Medicaid |
$440.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,967.73
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,535.26
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,902.86
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.57 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: ASR ASR |
$323.66
|
| Rate for Payer: BCBS Trust/PPO |
$258.69
|
| Rate for Payer: BCN Commercial |
$258.69
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$313.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Healthscope Whirlpool |
$323.66
|
| Rate for Payer: Mclaren Commercial |
$300.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.63
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: ASR ASR |
$323.66
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$258.69
|
| Rate for Payer: BCN Commercial |
$258.69
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$313.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Healthscope Whirlpool |
$323.66
|
| Rate for Payer: Mclaren Commercial |
$300.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.64
|
| Rate for Payer: Priority Health Narrow Network |
$236.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.63
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
OP
|
$256.22
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$389.44 |
| Rate for Payer: Aetna Commercial |
$230.60
|
| Rate for Payer: ASR ASR |
$248.53
|
| Rate for Payer: BCBS Complete |
$102.49
|
| Rate for Payer: BCBS Trust/PPO |
$198.65
|
| Rate for Payer: BCCCP Commercial |
$59.82
|
| Rate for Payer: BCN Commercial |
$198.65
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cofinity Commercial |
$240.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.98
|
| Rate for Payer: Healthscope Commercial |
$256.22
|
| Rate for Payer: Healthscope Whirlpool |
$248.53
|
| Rate for Payer: Mclaren Commercial |
$230.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.44
|
| Rate for Payer: Priority Health Narrow Network |
$311.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.47
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
IP
|
$256.22
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$256.22 |
| Rate for Payer: Aetna Commercial |
$230.60
|
| Rate for Payer: ASR ASR |
$248.53
|
| Rate for Payer: BCBS Trust/PPO |
$198.65
|
| Rate for Payer: BCN Commercial |
$198.65
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cofinity Commercial |
$240.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.98
|
| Rate for Payer: Healthscope Commercial |
$256.22
|
| Rate for Payer: Healthscope Whirlpool |
$248.53
|
| Rate for Payer: Mclaren Commercial |
$230.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.47
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.79
|
| Rate for Payer: Priority Health Narrow Network |
$270.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
