|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,444.17 |
| Max. Negotiated Rate |
$5,298.73 |
| Rate for Payer: Aetna Commercial |
$4,768.86
|
| Rate for Payer: ASR ASR |
$5,139.77
|
| Rate for Payer: ASR Commercial |
$5,139.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,317.94
|
| Rate for Payer: BCN Commercial |
$4,108.11
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$4,980.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$5,298.73
|
| Rate for Payer: Healthscope Whirlpool |
$5,139.77
|
| Rate for Payer: Mclaren Commercial |
$4,768.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: Nomi Health Commercial |
$4,344.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,662.88
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,158.10 |
| Max. Negotiated Rate |
$9,474.00 |
| Rate for Payer: Aetna Commercial |
$8,526.60
|
| Rate for Payer: ASR ASR |
$9,189.78
|
| Rate for Payer: ASR Commercial |
$9,189.78
|
| Rate for Payer: BCBS Trust/PPO |
$7,720.36
|
| Rate for Payer: BCN Commercial |
$7,345.19
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,905.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Healthscope Commercial |
$9,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,189.78
|
| Rate for Payer: Mclaren Commercial |
$8,526.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,337.12
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,474.00 |
| Rate for Payer: Aetna Commercial |
$8,526.60
|
| Rate for Payer: Aetna Medicare |
$3,363.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: ASR ASR |
$9,189.78
|
| Rate for Payer: ASR Commercial |
$9,189.78
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCBS Trust/PPO |
$7,758.26
|
| Rate for Payer: BCN Commercial |
$7,345.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,905.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$9,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,189.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,363.71
|
| Rate for Payer: Mclaren Commercial |
$8,526.60
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$3,700.08
|
| Rate for Payer: PHP Medicaid |
$1,802.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,301.12
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health Narrow Network |
$6,641.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,337.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$5,213.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP DNSP |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: Aetna Medicare |
$247.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS Trust/PPO |
$405.36
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.72
|
| Rate for Payer: Priority Health Narrow Network |
$347.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Trust/PPO |
$403.38
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,108.54 |
| Max. Negotiated Rate |
$2,771.34 |
| Rate for Payer: Aetna Commercial |
$2,494.21
|
| Rate for Payer: Aetna Medicare |
$1,385.67
|
| Rate for Payer: ASR ASR |
$2,688.20
|
| Rate for Payer: ASR Commercial |
$2,688.20
|
| Rate for Payer: BCBS Complete |
$1,108.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.45
|
| Rate for Payer: BCN Commercial |
$2,148.62
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$2,605.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,771.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,688.20
|
| Rate for Payer: Mclaren Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: Nomi Health Commercial |
$2,272.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,428.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,942.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,438.78
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,801.37 |
| Max. Negotiated Rate |
$2,771.34 |
| Rate for Payer: Aetna Commercial |
$2,494.21
|
| Rate for Payer: ASR ASR |
$2,688.20
|
| Rate for Payer: ASR Commercial |
$2,688.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,258.36
|
| Rate for Payer: BCN Commercial |
$2,148.62
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$2,605.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,771.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,688.20
|
| Rate for Payer: Mclaren Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: Nomi Health Commercial |
$2,272.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,438.78
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: BCBS Trust/PPO |
$6,565.29
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,024.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,620.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,211.18 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,533.22
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,211.18 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,533.22
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: BCBS Trust/PPO |
$6,565.29
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,024.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,620.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,040.82 |
| Max. Negotiated Rate |
$5,102.04 |
| Rate for Payer: Aetna Commercial |
$4,591.84
|
| Rate for Payer: Aetna Medicare |
$2,551.02
|
| Rate for Payer: ASR ASR |
$4,948.98
|
| Rate for Payer: ASR Commercial |
$4,948.98
|
| Rate for Payer: BCBS Complete |
$2,040.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.06
|
| Rate for Payer: BCN Commercial |
$3,955.61
|
| Rate for Payer: Cash Price |
$4,081.63
|
| Rate for Payer: Cofinity Commercial |
$4,795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,081.63
|
| Rate for Payer: Healthscope Commercial |
$5,102.04
|
| Rate for Payer: Healthscope Whirlpool |
$4,948.98
|
| Rate for Payer: Mclaren Commercial |
$4,591.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,336.73
|
| Rate for Payer: Nomi Health Commercial |
$4,183.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,470.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,576.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,489.80
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,316.33 |
| Max. Negotiated Rate |
$5,102.04 |
| Rate for Payer: Aetna Commercial |
$4,591.84
|
| Rate for Payer: ASR ASR |
$4,948.98
|
| Rate for Payer: ASR Commercial |
$4,948.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,157.65
|
| Rate for Payer: BCN Commercial |
$3,955.61
|
| Rate for Payer: Cash Price |
$4,081.63
|
| Rate for Payer: Cofinity Commercial |
$4,795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,081.63
|
| Rate for Payer: Healthscope Commercial |
$5,102.04
|
| Rate for Payer: Healthscope Whirlpool |
$4,948.98
|
| Rate for Payer: Mclaren Commercial |
$4,591.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,336.73
|
| Rate for Payer: Nomi Health Commercial |
$4,183.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,489.80
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
OP
|
$788.46
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$788.46 |
| Rate for Payer: Aetna Commercial |
$709.61
|
| Rate for Payer: Aetna Medicare |
$394.23
|
| Rate for Payer: ASR ASR |
$764.81
|
| Rate for Payer: ASR Commercial |
$764.81
|
| Rate for Payer: BCBS Complete |
$315.38
|
| Rate for Payer: BCBS Trust/PPO |
$645.67
|
| Rate for Payer: BCN Commercial |
$611.29
|
| Rate for Payer: Cash Price |
$630.77
|
| Rate for Payer: Cofinity Commercial |
$741.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.77
|
| Rate for Payer: Healthscope Commercial |
$788.46
|
| Rate for Payer: Healthscope Whirlpool |
$764.81
|
| Rate for Payer: Mclaren Commercial |
$709.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.19
|
| Rate for Payer: Nomi Health Commercial |
$646.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.85
|
| Rate for Payer: Priority Health Narrow Network |
$552.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.84
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
IP
|
$788.46
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.50 |
| Max. Negotiated Rate |
$788.46 |
| Rate for Payer: Aetna Commercial |
$709.61
|
| Rate for Payer: ASR ASR |
$764.81
|
| Rate for Payer: ASR Commercial |
$764.81
|
| Rate for Payer: BCBS Trust/PPO |
$642.52
|
| Rate for Payer: BCN Commercial |
$611.29
|
| Rate for Payer: Cash Price |
$630.77
|
| Rate for Payer: Cofinity Commercial |
$741.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.77
|
| Rate for Payer: Healthscope Commercial |
$788.46
|
| Rate for Payer: Healthscope Whirlpool |
$764.81
|
| Rate for Payer: Mclaren Commercial |
$709.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.19
|
| Rate for Payer: Nomi Health Commercial |
$646.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.84
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
OP
|
$2,996.76
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.70 |
| Max. Negotiated Rate |
$2,996.76 |
| Rate for Payer: Aetna Commercial |
$2,697.08
|
| Rate for Payer: Aetna Medicare |
$1,498.38
|
| Rate for Payer: ASR ASR |
$2,906.86
|
| Rate for Payer: ASR Commercial |
$2,906.86
|
| Rate for Payer: BCBS Complete |
$1,198.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,454.05
|
| Rate for Payer: BCN Commercial |
$2,323.39
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cofinity Commercial |
$2,816.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,397.41
|
| Rate for Payer: Healthscope Commercial |
$2,996.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,906.86
|
| Rate for Payer: Mclaren Commercial |
$2,697.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,547.25
|
| Rate for Payer: Nomi Health Commercial |
$2,457.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,625.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,100.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,637.15
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
IP
|
$2,996.76
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,947.89 |
| Max. Negotiated Rate |
$2,996.76 |
| Rate for Payer: Aetna Commercial |
$2,697.08
|
| Rate for Payer: ASR ASR |
$2,906.86
|
| Rate for Payer: ASR Commercial |
$2,906.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.06
|
| Rate for Payer: BCN Commercial |
$2,323.39
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cofinity Commercial |
$2,816.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,397.41
|
| Rate for Payer: Healthscope Commercial |
$2,996.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,906.86
|
| Rate for Payer: Mclaren Commercial |
$2,697.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,547.25
|
| Rate for Payer: Nomi Health Commercial |
$2,457.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,637.15
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
OP
|
$4,078.88
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,956.51
|
| Rate for Payer: ASR Commercial |
$3,956.51
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,340.19
|
| Rate for Payer: BCN Commercial |
$3,162.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cofinity Commercial |
$3,834.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,078.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,670.99
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.05
|
| Rate for Payer: Nomi Health Commercial |
$3,344.68
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,573.91
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,859.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,589.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
IP
|
$4,078.88
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,651.27 |
| Max. Negotiated Rate |
$4,078.88 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: ASR ASR |
$3,956.51
|
| Rate for Payer: ASR Commercial |
$3,956.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,323.88
|
| Rate for Payer: BCN Commercial |
$3,162.36
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cofinity Commercial |
$3,834.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.10
|
| Rate for Payer: Healthscope Commercial |
$4,078.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.51
|
| Rate for Payer: Mclaren Commercial |
$3,670.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.05
|
| Rate for Payer: Nomi Health Commercial |
$3,344.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,589.41
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
IP
|
$261.53
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.99 |
| Max. Negotiated Rate |
$261.53 |
| Rate for Payer: Aetna Commercial |
$235.38
|
| Rate for Payer: ASR ASR |
$253.68
|
| Rate for Payer: ASR Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$213.12
|
| Rate for Payer: BCN Commercial |
$202.76
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cofinity Commercial |
$245.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$261.53
|
| Rate for Payer: Healthscope Whirlpool |
$253.68
|
| Rate for Payer: Mclaren Commercial |
$235.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.30
|
| Rate for Payer: Nomi Health Commercial |
$214.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.15
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
OP
|
$261.53
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$261.53 |
| Rate for Payer: Aetna Commercial |
$235.38
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| Rate for Payer: ASR ASR |
$253.68
|
| Rate for Payer: ASR Commercial |
$253.68
|
| Rate for Payer: BCBS Complete |
$104.61
|
| Rate for Payer: BCBS Trust/PPO |
$214.17
|
| Rate for Payer: BCN Commercial |
$202.76
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cofinity Commercial |
$245.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$261.53
|
| Rate for Payer: Healthscope Whirlpool |
$253.68
|
| Rate for Payer: Mclaren Commercial |
$235.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.30
|
| Rate for Payer: Nomi Health Commercial |
$214.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.15
|
| Rate for Payer: Priority Health Narrow Network |
$183.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.15
|
|
|
HC ENDOVENOUS LASER 1ST VEIN
|
Facility
|
IP
|
$4,122.36
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
76100184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,679.53 |
| Max. Negotiated Rate |
$4,122.36 |
| Rate for Payer: Aetna Commercial |
$3,710.12
|
| Rate for Payer: ASR ASR |
$3,998.69
|
| Rate for Payer: ASR Commercial |
$3,998.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,359.31
|
| Rate for Payer: BCN Commercial |
$3,196.07
|
| Rate for Payer: Cash Price |
$3,297.89
|
| Rate for Payer: Cofinity Commercial |
$3,875.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,297.89
|
| Rate for Payer: Healthscope Commercial |
$4,122.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,998.69
|
| Rate for Payer: Mclaren Commercial |
$3,710.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,504.01
|
| Rate for Payer: Nomi Health Commercial |
$3,380.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,679.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,627.68
|
|
|
HC ENDOVENOUS LASER 1ST VEIN
|
Facility
|
OP
|
$4,122.36
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
76100184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,710.12
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,998.69
|
| Rate for Payer: ASR Commercial |
$3,998.69
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,375.80
|
| Rate for Payer: BCN Commercial |
$3,196.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,297.89
|
| Rate for Payer: Cash Price |
$3,297.89
|
| Rate for Payer: Cofinity Commercial |
$3,875.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,297.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,122.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,998.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,710.12
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,504.01
|
| Rate for Payer: Nomi Health Commercial |
$3,380.34
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,679.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,612.01
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,889.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,627.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
