|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$234.93
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.36
|
| Rate for Payer: Priority Health Narrow Network |
$201.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.47 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Trust/PPO |
$233.78
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$419.62 |
| Rate for Payer: Aetna Commercial |
$377.66
|
| Rate for Payer: ASR ASR |
$407.03
|
| Rate for Payer: ASR Commercial |
$407.03
|
| Rate for Payer: BCBS Trust/PPO |
$341.95
|
| Rate for Payer: BCN Commercial |
$325.33
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$394.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$419.62
|
| Rate for Payer: Healthscope Whirlpool |
$407.03
|
| Rate for Payer: Mclaren Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.27
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.85 |
| Max. Negotiated Rate |
$419.62 |
| Rate for Payer: Aetna Commercial |
$377.66
|
| Rate for Payer: Aetna Medicare |
$209.81
|
| Rate for Payer: ASR ASR |
$407.03
|
| Rate for Payer: ASR Commercial |
$407.03
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: BCBS Trust/PPO |
$343.63
|
| Rate for Payer: BCN Commercial |
$325.33
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$394.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$419.62
|
| Rate for Payer: Healthscope Whirlpool |
$407.03
|
| Rate for Payer: Mclaren Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.67
|
| Rate for Payer: Priority Health Narrow Network |
$294.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.27
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.30 |
| Max. Negotiated Rate |
$538.93 |
| Rate for Payer: Aetna Commercial |
$485.04
|
| Rate for Payer: ASR ASR |
$522.76
|
| Rate for Payer: ASR Commercial |
$522.76
|
| Rate for Payer: BCBS Trust/PPO |
$439.17
|
| Rate for Payer: BCN Commercial |
$417.83
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$506.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$538.93
|
| Rate for Payer: Healthscope Whirlpool |
$522.76
|
| Rate for Payer: Mclaren Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.26
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$538.93 |
| Rate for Payer: Aetna Commercial |
$485.04
|
| Rate for Payer: Aetna Medicare |
$269.46
|
| Rate for Payer: ASR ASR |
$522.76
|
| Rate for Payer: ASR Commercial |
$522.76
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: BCBS Trust/PPO |
$441.33
|
| Rate for Payer: BCN Commercial |
$417.83
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$506.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$538.93
|
| Rate for Payer: Healthscope Whirlpool |
$522.76
|
| Rate for Payer: Mclaren Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.21
|
| Rate for Payer: Priority Health Narrow Network |
$377.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.26
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Aetna Commercial |
$62.35
|
| Rate for Payer: ASR ASR |
$67.20
|
| Rate for Payer: ASR Commercial |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.46
|
| Rate for Payer: BCN Commercial |
$53.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$69.28
|
| Rate for Payer: Healthscope Whirlpool |
$67.20
|
| Rate for Payer: Mclaren Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.97
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Aetna Commercial |
$62.35
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: ASR ASR |
$67.20
|
| Rate for Payer: ASR Commercial |
$67.20
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.73
|
| Rate for Payer: BCN Commercial |
$53.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$69.28
|
| Rate for Payer: Healthscope Whirlpool |
$67.20
|
| Rate for Payer: Mclaren Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.70
|
| Rate for Payer: Priority Health Narrow Network |
$48.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.97
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,743.00 |
| Max. Negotiated Rate |
$11,857.50 |
| Rate for Payer: Aetna Commercial |
$10,671.75
|
| Rate for Payer: Aetna Medicare |
$5,928.75
|
| Rate for Payer: ASR ASR |
$11,501.78
|
| Rate for Payer: ASR Commercial |
$11,501.78
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: BCBS Trust/PPO |
$9,710.11
|
| Rate for Payer: BCN Commercial |
$9,193.12
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$11,146.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$11,857.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,501.78
|
| Rate for Payer: Mclaren Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,389.54
|
| Rate for Payer: Priority Health Narrow Network |
$8,312.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,434.60
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,707.38 |
| Max. Negotiated Rate |
$11,857.50 |
| Rate for Payer: Aetna Commercial |
$10,671.75
|
| Rate for Payer: ASR ASR |
$11,501.78
|
| Rate for Payer: ASR Commercial |
$11,501.78
|
| Rate for Payer: BCBS Trust/PPO |
$9,662.68
|
| Rate for Payer: BCN Commercial |
$9,193.12
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$11,146.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$11,857.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,501.78
|
| Rate for Payer: Mclaren Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,434.60
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$5,656.01 |
| Rate for Payer: Aetna Commercial |
$5,090.41
|
| Rate for Payer: Aetna Medicare |
$2,828.00
|
| Rate for Payer: ASR ASR |
$5,486.33
|
| Rate for Payer: ASR Commercial |
$5,486.33
|
| Rate for Payer: BCBS Complete |
$2,262.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,631.71
|
| Rate for Payer: BCN Commercial |
$4,385.10
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$5,316.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Healthscope Commercial |
$5,656.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,486.33
|
| Rate for Payer: Mclaren Commercial |
$5,090.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: Nomi Health Commercial |
$4,637.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,955.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,964.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,977.29
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,676.41 |
| Max. Negotiated Rate |
$5,656.01 |
| Rate for Payer: Aetna Commercial |
$5,090.41
|
| Rate for Payer: ASR ASR |
$5,486.33
|
| Rate for Payer: ASR Commercial |
$5,486.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,609.08
|
| Rate for Payer: BCN Commercial |
$4,385.10
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$5,316.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Healthscope Commercial |
$5,656.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,486.33
|
| Rate for Payer: Mclaren Commercial |
$5,090.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: Nomi Health Commercial |
$4,637.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,977.29
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,330.19 |
| Max. Negotiated Rate |
$2,046.45 |
| Rate for Payer: Aetna Commercial |
$1,841.80
|
| Rate for Payer: ASR ASR |
$1,985.06
|
| Rate for Payer: ASR Commercial |
$1,985.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,667.65
|
| Rate for Payer: BCN Commercial |
$1,586.61
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,923.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Healthscope Commercial |
$2,046.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,985.06
|
| Rate for Payer: Mclaren Commercial |
$1,841.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: Nomi Health Commercial |
$1,678.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,800.88
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$2,046.45 |
| Rate for Payer: Aetna Commercial |
$1,841.80
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,985.06
|
| Rate for Payer: ASR Commercial |
$1,985.06
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.84
|
| Rate for Payer: BCN Commercial |
$1,586.61
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,923.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$2,046.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,985.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,841.80
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: Nomi Health Commercial |
$1,678.09
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,793.10
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,434.56
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,800.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$795.50 |
| Rate for Payer: Aetna Commercial |
$715.95
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$771.64
|
| Rate for Payer: ASR Commercial |
$771.64
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$651.43
|
| Rate for Payer: BCN Commercial |
$616.75
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cofinity Commercial |
$747.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$795.50
|
| Rate for Payer: Healthscope Whirlpool |
$771.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$715.95
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.18
|
| Rate for Payer: Nomi Health Commercial |
$652.31
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.02
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$557.65
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$517.08 |
| Max. Negotiated Rate |
$795.50 |
| Rate for Payer: Aetna Commercial |
$715.95
|
| Rate for Payer: ASR ASR |
$771.64
|
| Rate for Payer: ASR Commercial |
$771.64
|
| Rate for Payer: BCBS Trust/PPO |
$648.25
|
| Rate for Payer: BCN Commercial |
$616.75
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cofinity Commercial |
$747.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.40
|
| Rate for Payer: Healthscope Commercial |
$795.50
|
| Rate for Payer: Healthscope Whirlpool |
$771.64
|
| Rate for Payer: Mclaren Commercial |
$715.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.18
|
| Rate for Payer: Nomi Health Commercial |
$652.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.04
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$16,782.27
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,955.64 |
| Max. Negotiated Rate |
$17,222.45 |
| Rate for Payer: Aetna Commercial |
$15,104.04
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: ASR ASR |
$16,278.80
|
| Rate for Payer: ASR Commercial |
$16,278.80
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$13,743.00
|
| Rate for Payer: BCN Commercial |
$13,011.29
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cofinity Commercial |
$15,775.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,425.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$16,782.27
|
| Rate for Payer: Healthscope Whirlpool |
$16,278.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$15,104.04
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,264.93
|
| Rate for Payer: Nomi Health Commercial |
$13,761.46
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,123.97
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$8,099.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,768.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$16,782.27
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,908.48 |
| Max. Negotiated Rate |
$16,782.27 |
| Rate for Payer: Aetna Commercial |
$15,104.04
|
| Rate for Payer: ASR ASR |
$16,278.80
|
| Rate for Payer: ASR Commercial |
$16,278.80
|
| Rate for Payer: BCBS Trust/PPO |
$13,675.87
|
| Rate for Payer: BCN Commercial |
$13,011.29
|
| Rate for Payer: Cash Price |
$13,425.82
|
| Rate for Payer: Cofinity Commercial |
$15,775.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,425.82
|
| Rate for Payer: Healthscope Commercial |
$16,782.27
|
| Rate for Payer: Healthscope Whirlpool |
$16,278.80
|
| Rate for Payer: Mclaren Commercial |
$15,104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,264.93
|
| Rate for Payer: Nomi Health Commercial |
$13,761.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,768.40
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,386.35
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,951.13 |
| Max. Negotiated Rate |
$18,386.35 |
| Rate for Payer: Aetna Commercial |
$16,547.72
|
| Rate for Payer: ASR ASR |
$17,834.76
|
| Rate for Payer: ASR Commercial |
$17,834.76
|
| Rate for Payer: BCBS Trust/PPO |
$14,983.04
|
| Rate for Payer: BCN Commercial |
$14,254.94
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cofinity Commercial |
$17,283.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,709.08
|
| Rate for Payer: Healthscope Commercial |
$18,386.35
|
| Rate for Payer: Healthscope Whirlpool |
$17,834.76
|
| Rate for Payer: Mclaren Commercial |
$16,547.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,628.40
|
| Rate for Payer: Nomi Health Commercial |
$15,076.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,951.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,179.99
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,386.35
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,099.18 |
| Max. Negotiated Rate |
$27,270.14 |
| Rate for Payer: Aetna Commercial |
$16,547.72
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$17,834.76
|
| Rate for Payer: ASR Commercial |
$17,834.76
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,056.58
|
| Rate for Payer: BCN Commercial |
$14,254.94
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cash Price |
$14,709.08
|
| Rate for Payer: Cofinity Commercial |
$17,283.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,709.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$18,386.35
|
| Rate for Payer: Healthscope Whirlpool |
$17,834.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$16,547.72
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,628.40
|
| Rate for Payer: Nomi Health Commercial |
$15,076.81
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,951.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,123.97
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$8,099.18
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,179.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,628.69
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,958.65 |
| Max. Negotiated Rate |
$7,628.69 |
| Rate for Payer: Aetna Commercial |
$6,865.82
|
| Rate for Payer: ASR ASR |
$7,399.83
|
| Rate for Payer: ASR Commercial |
$7,399.83
|
| Rate for Payer: BCBS Trust/PPO |
$6,216.62
|
| Rate for Payer: BCN Commercial |
$5,914.52
|
| Rate for Payer: Cash Price |
$6,102.95
|
| Rate for Payer: Cofinity Commercial |
$7,170.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,102.95
|
| Rate for Payer: Healthscope Commercial |
$7,628.69
|
| Rate for Payer: Healthscope Whirlpool |
$7,399.83
|
| Rate for Payer: Mclaren Commercial |
$6,865.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,484.39
|
| Rate for Payer: Nomi Health Commercial |
$6,255.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,713.25
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,628.69
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,051.48 |
| Max. Negotiated Rate |
$7,628.69 |
| Rate for Payer: Aetna Commercial |
$6,865.82
|
| Rate for Payer: Aetna Medicare |
$3,814.34
|
| Rate for Payer: ASR ASR |
$7,399.83
|
| Rate for Payer: ASR Commercial |
$7,399.83
|
| Rate for Payer: BCBS Complete |
$3,051.48
|
| Rate for Payer: BCBS Trust/PPO |
$6,247.13
|
| Rate for Payer: BCN Commercial |
$5,914.52
|
| Rate for Payer: Cash Price |
$6,102.95
|
| Rate for Payer: Cofinity Commercial |
$7,170.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,102.95
|
| Rate for Payer: Healthscope Commercial |
$7,628.69
|
| Rate for Payer: Healthscope Whirlpool |
$7,399.83
|
| Rate for Payer: Mclaren Commercial |
$6,865.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,484.39
|
| Rate for Payer: Nomi Health Commercial |
$6,255.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,684.26
|
| Rate for Payer: Priority Health Narrow Network |
$5,347.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,713.25
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
OP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Aetna Commercial |
$1,686.82
|
| Rate for Payer: Aetna Medicare |
$937.12
|
| Rate for Payer: ASR ASR |
$1,818.02
|
| Rate for Payer: ASR Commercial |
$1,818.02
|
| Rate for Payer: BCBS Complete |
$749.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,534.82
|
| Rate for Payer: BCN Commercial |
$1,453.11
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cofinity Commercial |
$1,761.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,874.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,818.02
|
| Rate for Payer: Mclaren Commercial |
$1,686.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.11
|
| Rate for Payer: Nomi Health Commercial |
$1,536.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,313.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.34
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
IP
|
$1,874.25
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.26 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Aetna Commercial |
$1,686.82
|
| Rate for Payer: ASR ASR |
$1,818.02
|
| Rate for Payer: ASR Commercial |
$1,818.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.33
|
| Rate for Payer: BCN Commercial |
$1,453.11
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cofinity Commercial |
$1,761.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,499.40
|
| Rate for Payer: Healthscope Commercial |
$1,874.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,818.02
|
| Rate for Payer: Mclaren Commercial |
$1,686.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.11
|
| Rate for Payer: Nomi Health Commercial |
$1,536.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.34
|
|
|
HC EMBOLIZATION COILS LVL 1
|
Facility
|
OP
|
$160.65
|
|
| Hospital Charge Code |
27800091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: Aetna Medicare |
$80.32
|
| Rate for Payer: ASR ASR |
$155.83
|
| Rate for Payer: ASR Commercial |
$155.83
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: BCBS Trust/PPO |
$131.56
|
| Rate for Payer: BCN Commercial |
$124.55
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Healthscope Whirlpool |
$155.83
|
| Rate for Payer: Mclaren Commercial |
$144.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.76
|
| Rate for Payer: Priority Health Narrow Network |
$112.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.37
|
|
