|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
IP
|
$1,537.04
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,152.78 |
| Max. Negotiated Rate |
$1,537.04 |
| Rate for Payer: Aetna Commercial |
$1,383.34
|
| Rate for Payer: ASR ASR |
$1,490.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.22
|
| Rate for Payer: BCN Commercial |
$1,262.22
|
| Rate for Payer: Cash Price |
$1,229.63
|
| Rate for Payer: Cofinity Commercial |
$1,444.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.63
|
| Rate for Payer: Healthscope Commercial |
$1,490.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,537.04
|
| Rate for Payer: Mclaren Commercial |
$1,383.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.48
|
| Rate for Payer: Nomi Health Commercial |
$1,260.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.60
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
IP
|
$2,249.70
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,687.28 |
| Max. Negotiated Rate |
$2,249.70 |
| Rate for Payer: Aetna Commercial |
$2,024.73
|
| Rate for Payer: ASR ASR |
$2,182.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.45
|
| Rate for Payer: BCN Commercial |
$1,847.45
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cofinity Commercial |
$2,114.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.76
|
| Rate for Payer: Healthscope Commercial |
$2,182.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,249.70
|
| Rate for Payer: Mclaren Commercial |
$2,024.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.24
|
| Rate for Payer: Nomi Health Commercial |
$1,844.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,979.74
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
OP
|
$2,249.70
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,249.70 |
| Rate for Payer: Aetna Commercial |
$2,024.73
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$2,182.21
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.88
|
| Rate for Payer: BCN Commercial |
$1,854.88
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cash Price |
$1,799.76
|
| Rate for Payer: Cofinity Commercial |
$2,114.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$2,182.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,249.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$2,024.73
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.24
|
| Rate for Payer: Nomi Health Commercial |
$1,844.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.28
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,971.19
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,577.04
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,979.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$1,400.77
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: Aetna Medicare |
$128.45
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Complete |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$286.23
|
| Rate for Payer: BCN Commercial |
$286.23
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.17
|
| Rate for Payer: Priority Health Narrow Network |
$243.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Trust/PPO |
$285.08
|
| Rate for Payer: BCN Commercial |
$285.08
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
OP
|
$266.57
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$459.42 |
| Rate for Payer: Aetna Commercial |
$239.91
|
| Rate for Payer: Aetna Medicare |
$98.63
|
| Rate for Payer: ASR ASR |
$258.57
|
| Rate for Payer: BCBS Complete |
$106.63
|
| Rate for Payer: BCBS Trust/PPO |
$219.79
|
| Rate for Payer: BCCCP Commercial |
$55.83
|
| Rate for Payer: BCN Commercial |
$219.79
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cofinity Commercial |
$250.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.26
|
| Rate for Payer: Healthscope Commercial |
$258.57
|
| Rate for Payer: Healthscope Whirlpool |
$266.57
|
| Rate for Payer: Mclaren Commercial |
$239.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.58
|
| Rate for Payer: Nomi Health Commercial |
$218.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.42
|
| Rate for Payer: Priority Health Narrow Network |
$367.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.58
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
IP
|
$266.57
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$199.93 |
| Max. Negotiated Rate |
$266.57 |
| Rate for Payer: Aetna Commercial |
$239.91
|
| Rate for Payer: ASR ASR |
$258.57
|
| Rate for Payer: BCBS Trust/PPO |
$218.91
|
| Rate for Payer: BCN Commercial |
$218.91
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cofinity Commercial |
$250.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.26
|
| Rate for Payer: Healthscope Commercial |
$258.57
|
| Rate for Payer: Healthscope Whirlpool |
$266.57
|
| Rate for Payer: Mclaren Commercial |
$239.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.58
|
| Rate for Payer: Nomi Health Commercial |
$218.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.58
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Aetna Medicare |
$146.70
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.40
|
| Rate for Payer: Priority Health Narrow Network |
$277.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC IR GUIDEWIRE
|
Facility
|
OP
|
$45.63
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$45.63 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: Aetna Medicare |
$16.88
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Complete |
$18.25
|
| Rate for Payer: BCBS Trust/PPO |
$37.62
|
| Rate for Payer: BCN Commercial |
$37.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.98
|
| Rate for Payer: Priority Health Narrow Network |
$31.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
|
|
HC IR GUIDEWIRE
|
Facility
|
IP
|
$45.63
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$45.63 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$37.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.79 |
| Max. Negotiated Rate |
$495.72 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Trust/PPO |
$407.09
|
| Rate for Payer: BCN Commercial |
$407.09
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$538.81 |
| Rate for Payer: Aetna Commercial |
$446.15
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$480.85
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$408.72
|
| Rate for Payer: BCN Commercial |
$408.72
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$465.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$480.85
|
| Rate for Payer: Healthscope Whirlpool |
$495.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$426.10
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$340.88
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
OP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$843.90 |
| Rate for Payer: Aetna Commercial |
$757.98
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$816.93
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$694.39
|
| Rate for Payer: BCN Commercial |
$694.39
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Commercial |
$791.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$816.93
|
| Rate for Payer: Healthscope Whirlpool |
$842.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$757.98
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$299.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Nomi Health Commercial |
$690.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$737.94
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$590.38
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
IP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$631.65 |
| Max. Negotiated Rate |
$842.20 |
| Rate for Payer: Aetna Commercial |
$757.98
|
| Rate for Payer: ASR ASR |
$816.93
|
| Rate for Payer: BCBS Trust/PPO |
$691.61
|
| Rate for Payer: BCN Commercial |
$691.61
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Commercial |
$791.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Healthscope Commercial |
$816.93
|
| Rate for Payer: Healthscope Whirlpool |
$842.20
|
| Rate for Payer: Mclaren Commercial |
$757.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Nomi Health Commercial |
$690.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.14
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
IP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,497.87 |
| Max. Negotiated Rate |
$1,997.16 |
| Rate for Payer: Aetna Commercial |
$1,797.44
|
| Rate for Payer: ASR ASR |
$1,937.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.07
|
| Rate for Payer: BCN Commercial |
$1,640.07
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Commercial |
$1,877.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Healthscope Commercial |
$1,937.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.16
|
| Rate for Payer: Mclaren Commercial |
$1,797.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Nomi Health Commercial |
$1,637.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,757.50
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
OP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$1,797.44
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$1,937.25
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.66
|
| Rate for Payer: BCN Commercial |
$1,646.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Commercial |
$1,877.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$1,937.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$1,797.44
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Nomi Health Commercial |
$1,637.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,749.91
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,400.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,757.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
OP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,950.97
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$4,258.27
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,619.53
|
| Rate for Payer: BCN Commercial |
$3,619.53
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Commercial |
$4,126.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,258.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,389.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,950.97
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Nomi Health Commercial |
$3,599.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,846.49
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,077.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,863.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
IP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,292.48 |
| Max. Negotiated Rate |
$4,389.97 |
| Rate for Payer: Aetna Commercial |
$3,950.97
|
| Rate for Payer: ASR ASR |
$4,258.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,605.04
|
| Rate for Payer: BCN Commercial |
$3,605.04
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Commercial |
$4,126.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Healthscope Commercial |
$4,258.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,389.97
|
| Rate for Payer: Mclaren Commercial |
$3,950.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Nomi Health Commercial |
$3,599.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,863.17
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
OP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,185.79
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,433.58
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,918.54
|
| Rate for Payer: BCN Commercial |
$2,918.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Commercial |
$3,327.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,433.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,539.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,185.79
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Nomi Health Commercial |
$2,902.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,101.55
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,481.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,115.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
IP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,654.83 |
| Max. Negotiated Rate |
$3,539.77 |
| Rate for Payer: Aetna Commercial |
$3,185.79
|
| Rate for Payer: ASR ASR |
$3,433.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,906.86
|
| Rate for Payer: BCN Commercial |
$2,906.86
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Commercial |
$3,327.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Healthscope Commercial |
$3,433.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,539.77
|
| Rate for Payer: Mclaren Commercial |
$3,185.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Nomi Health Commercial |
$2,902.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,115.00
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
IP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$970.05 |
| Max. Negotiated Rate |
$1,293.40 |
| Rate for Payer: Aetna Commercial |
$1,164.06
|
| Rate for Payer: ASR ASR |
$1,254.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.14
|
| Rate for Payer: BCN Commercial |
$1,062.14
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Commercial |
$1,215.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,293.40
|
| Rate for Payer: Mclaren Commercial |
$1,164.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Nomi Health Commercial |
$1,060.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,138.19
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
OP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,164.06
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,254.60
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.41
|
| Rate for Payer: BCN Commercial |
$1,066.41
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Commercial |
$1,215.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,293.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,164.06
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Nomi Health Commercial |
$1,060.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,133.28
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$906.67
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,138.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
OP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,683.91 |
| Rate for Payer: Aetna Commercial |
$1,515.52
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,633.39
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.38
|
| Rate for Payer: BCN Commercial |
$1,388.38
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Commercial |
$1,582.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,633.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,683.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,515.52
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Nomi Health Commercial |
$1,380.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,475.44
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.42
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,481.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
IP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,262.93 |
| Max. Negotiated Rate |
$1,683.91 |
| Rate for Payer: Aetna Commercial |
$1,515.52
|
| Rate for Payer: ASR ASR |
$1,633.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.83
|
| Rate for Payer: BCN Commercial |
$1,382.83
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Commercial |
$1,582.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Healthscope Commercial |
$1,633.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,683.91
|
| Rate for Payer: Mclaren Commercial |
$1,515.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Nomi Health Commercial |
$1,380.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,481.84
|
|
