|
HC IR REVSC TPVT W ANGIO UNILAT SF INIT VESSEL
|
Facility
|
OP
|
$28,756.70
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
36100646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$28,756.70 |
| Rate for Payer: Aetna Commercial |
$25,881.03
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$27,894.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$23,709.90
|
| Rate for Payer: BCN Commercial |
$23,709.90
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$23,005.36
|
| Rate for Payer: Cash Price |
$23,005.36
|
| Rate for Payer: Cofinity Commercial |
$27,031.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,005.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$27,894.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,756.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$25,881.03
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,443.19
|
| Rate for Payer: Nomi Health Commercial |
$23,580.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,567.53
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,383.94
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$9,907.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,305.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC IR REVSC TPVT W ANGIO UNILAT SF INIT VESSEL
|
Facility
|
IP
|
$28,756.70
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
36100646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,567.53 |
| Max. Negotiated Rate |
$28,756.70 |
| Rate for Payer: Aetna Commercial |
$25,881.03
|
| Rate for Payer: ASR ASR |
$27,894.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,615.00
|
| Rate for Payer: BCN Commercial |
$23,615.00
|
| Rate for Payer: Cash Price |
$23,005.36
|
| Rate for Payer: Cofinity Commercial |
$27,031.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,005.36
|
| Rate for Payer: Healthscope Commercial |
$27,894.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,756.70
|
| Rate for Payer: Mclaren Commercial |
$25,881.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,443.19
|
| Rate for Payer: Nomi Health Commercial |
$23,580.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,567.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,305.90
|
|
|
HC IR REVSC TPVT W STENT UNILAT SF EA ADD
|
Facility
|
IP
|
$10,518.95
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
36100650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,889.21 |
| Max. Negotiated Rate |
$10,518.95 |
| Rate for Payer: Aetna Commercial |
$9,467.06
|
| Rate for Payer: ASR ASR |
$10,203.38
|
| Rate for Payer: BCBS Trust/PPO |
$8,638.16
|
| Rate for Payer: BCN Commercial |
$8,638.16
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$9,887.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$10,203.38
|
| Rate for Payer: Healthscope Whirlpool |
$10,518.95
|
| Rate for Payer: Mclaren Commercial |
$9,467.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: Nomi Health Commercial |
$8,625.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,889.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,256.68
|
|
|
HC IR REVSC TPVT W STENT UNILAT SF EA ADD
|
Facility
|
OP
|
$10,518.95
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
36100650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$10,518.95 |
| Rate for Payer: Aetna Commercial |
$9,467.06
|
| Rate for Payer: Aetna Medicare |
$3,892.01
|
| Rate for Payer: ASR ASR |
$10,203.38
|
| Rate for Payer: BCBS Complete |
$4,207.58
|
| Rate for Payer: BCBS Trust/PPO |
$8,672.87
|
| Rate for Payer: BCN Commercial |
$8,672.87
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$9,887.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$10,203.38
|
| Rate for Payer: Healthscope Whirlpool |
$10,518.95
|
| Rate for Payer: Mclaren Commercial |
$9,467.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,415.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: Nomi Health Commercial |
$8,625.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,889.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,362.31
|
| Rate for Payer: Priority Health Narrow Network |
$6,689.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,256.68
|
|
|
HC IR REVSC TPVT W STEN UNILAT COMPLEX EA ADD
|
Facility
|
OP
|
$10,518.95
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
36100651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$14,930.75 |
| Rate for Payer: Aetna Commercial |
$9,467.06
|
| Rate for Payer: Aetna Medicare |
$3,892.01
|
| Rate for Payer: ASR ASR |
$10,203.38
|
| Rate for Payer: BCBS Complete |
$4,207.58
|
| Rate for Payer: BCBS Trust/PPO |
$8,672.87
|
| Rate for Payer: BCN Commercial |
$8,672.87
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$9,887.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$10,203.38
|
| Rate for Payer: Healthscope Whirlpool |
$10,518.95
|
| Rate for Payer: Mclaren Commercial |
$9,467.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,415.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: Nomi Health Commercial |
$8,625.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,889.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,930.75
|
| Rate for Payer: Priority Health Narrow Network |
$11,944.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,256.68
|
|
|
HC IR REVSC TPVT W STEN UNILAT COMPLEX EA ADD
|
Facility
|
IP
|
$10,518.95
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
36100651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,889.21 |
| Max. Negotiated Rate |
$10,518.95 |
| Rate for Payer: Aetna Commercial |
$9,467.06
|
| Rate for Payer: ASR ASR |
$10,203.38
|
| Rate for Payer: BCBS Trust/PPO |
$8,638.16
|
| Rate for Payer: BCN Commercial |
$8,638.16
|
| Rate for Payer: Cash Price |
$8,415.16
|
| Rate for Payer: Cofinity Commercial |
$9,887.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,415.16
|
| Rate for Payer: Healthscope Commercial |
$10,203.38
|
| Rate for Payer: Healthscope Whirlpool |
$10,518.95
|
| Rate for Payer: Mclaren Commercial |
$9,467.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,941.11
|
| Rate for Payer: Nomi Health Commercial |
$8,625.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,889.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,256.68
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
OP
|
$185.90
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$167.31
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$180.32
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$153.27
|
| Rate for Payer: BCN Commercial |
$153.27
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$148.72
|
| Rate for Payer: Cash Price |
$148.72
|
| Rate for Payer: Cofinity Commercial |
$174.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$180.32
|
| Rate for Payer: Healthscope Whirlpool |
$185.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$167.31
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.01
|
| Rate for Payer: Nomi Health Commercial |
$152.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.43
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.33
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC IRRIGATE IMPLANTED VAD
|
Facility
|
IP
|
$185.90
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.43 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$167.31
|
| Rate for Payer: ASR ASR |
$180.32
|
| Rate for Payer: BCBS Trust/PPO |
$152.66
|
| Rate for Payer: BCN Commercial |
$152.66
|
| Rate for Payer: Cash Price |
$148.72
|
| Rate for Payer: Cofinity Commercial |
$174.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.72
|
| Rate for Payer: Healthscope Commercial |
$180.32
|
| Rate for Payer: Healthscope Whirlpool |
$185.90
|
| Rate for Payer: Mclaren Commercial |
$167.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.01
|
| Rate for Payer: Nomi Health Commercial |
$152.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.59
|
|
|
HC IRRIGATION CONE
|
Facility
|
OP
|
$44.48
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$44.48 |
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: ASR ASR |
$43.15
|
| Rate for Payer: BCBS Complete |
$17.79
|
| Rate for Payer: BCBS Trust/PPO |
$36.67
|
| Rate for Payer: BCN Commercial |
$36.67
|
| Rate for Payer: Cash Price |
$35.58
|
| Rate for Payer: Cofinity Commercial |
$41.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.58
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Healthscope Whirlpool |
$44.48
|
| Rate for Payer: Mclaren Commercial |
$40.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.81
|
| Rate for Payer: Nomi Health Commercial |
$36.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.97
|
| Rate for Payer: Priority Health Narrow Network |
$31.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.14
|
|
|
HC IRRIGATION CONE
|
Facility
|
IP
|
$44.48
|
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$44.48 |
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: ASR ASR |
$43.15
|
| Rate for Payer: BCBS Trust/PPO |
$36.53
|
| Rate for Payer: BCN Commercial |
$36.53
|
| Rate for Payer: Cash Price |
$35.58
|
| Rate for Payer: Cofinity Commercial |
$41.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.58
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Healthscope Whirlpool |
$44.48
|
| Rate for Payer: Mclaren Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.81
|
| Rate for Payer: Nomi Health Commercial |
$36.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.14
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Trust/PPO |
$302.51
|
| Rate for Payer: BCN Commercial |
$302.51
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
76100188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$303.72
|
| Rate for Payer: BCN Commercial |
$303.72
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.77
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$258.23
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
HC IRRIGATION SLEEVE
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
IP
|
$1,998.93
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,499.20 |
| Max. Negotiated Rate |
$1,998.93 |
| Rate for Payer: Aetna Commercial |
$1,799.04
|
| Rate for Payer: ASR ASR |
$1,938.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.52
|
| Rate for Payer: BCN Commercial |
$1,641.52
|
| Rate for Payer: Cash Price |
$1,599.14
|
| Rate for Payer: Cofinity Commercial |
$1,878.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.14
|
| Rate for Payer: Healthscope Commercial |
$1,938.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.93
|
| Rate for Payer: Mclaren Commercial |
$1,799.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.09
|
| Rate for Payer: Nomi Health Commercial |
$1,639.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,759.06
|
|
|
HC IR SELECTIVE EACH ADDITION VESSEL
|
Facility
|
OP
|
$1,998.93
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
32000200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$739.60 |
| Max. Negotiated Rate |
$1,998.93 |
| Rate for Payer: Aetna Commercial |
$1,799.04
|
| Rate for Payer: Aetna Medicare |
$739.60
|
| Rate for Payer: ASR ASR |
$1,938.96
|
| Rate for Payer: BCBS Complete |
$799.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,648.12
|
| Rate for Payer: BCN Commercial |
$1,648.12
|
| Rate for Payer: Cash Price |
$1,599.14
|
| Rate for Payer: Cofinity Commercial |
$1,878.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.14
|
| Rate for Payer: Healthscope Commercial |
$1,938.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.93
|
| Rate for Payer: Mclaren Commercial |
$1,799.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.09
|
| Rate for Payer: Nomi Health Commercial |
$1,639.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,751.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,401.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,759.06
|
|
|
HC IR SHEATH
|
Facility
|
IP
|
$238.77
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$214.89
|
| Rate for Payer: ASR ASR |
$231.61
|
| Rate for Payer: BCBS Trust/PPO |
$196.08
|
| Rate for Payer: BCN Commercial |
$196.08
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$231.61
|
| Rate for Payer: Healthscope Whirlpool |
$238.77
|
| Rate for Payer: Mclaren Commercial |
$214.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Nomi Health Commercial |
$195.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.12
|
|
|
HC IR SHEATH
|
Facility
|
OP
|
$238.77
|
|
| Hospital Charge Code |
27200314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.34 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$214.89
|
| Rate for Payer: Aetna Medicare |
$88.34
|
| Rate for Payer: ASR ASR |
$231.61
|
| Rate for Payer: BCBS Complete |
$95.51
|
| Rate for Payer: BCBS Trust/PPO |
$196.87
|
| Rate for Payer: BCN Commercial |
$196.87
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$231.61
|
| Rate for Payer: Healthscope Whirlpool |
$238.77
|
| Rate for Payer: Mclaren Commercial |
$214.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Nomi Health Commercial |
$195.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.21
|
| Rate for Payer: Priority Health Narrow Network |
$167.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.12
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
OP
|
$743.65
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$743.65 |
| Rate for Payer: Aetna Commercial |
$669.28
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$721.34
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$613.14
|
| Rate for Payer: BCN Commercial |
$613.14
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cofinity Commercial |
$699.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$721.34
|
| Rate for Payer: Healthscope Whirlpool |
$743.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$669.28
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.10
|
| Rate for Payer: Nomi Health Commercial |
$609.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.74
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$651.59
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$521.30
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC IR SHUNTOGRAM PREVIOUS SHUNT
|
Facility
|
IP
|
$743.65
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
32000202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$557.74 |
| Max. Negotiated Rate |
$743.65 |
| Rate for Payer: Aetna Commercial |
$669.28
|
| Rate for Payer: ASR ASR |
$721.34
|
| Rate for Payer: BCBS Trust/PPO |
$610.69
|
| Rate for Payer: BCN Commercial |
$610.69
|
| Rate for Payer: Cash Price |
$594.92
|
| Rate for Payer: Cofinity Commercial |
$699.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.92
|
| Rate for Payer: Healthscope Commercial |
$721.34
|
| Rate for Payer: Healthscope Whirlpool |
$743.65
|
| Rate for Payer: Mclaren Commercial |
$669.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.10
|
| Rate for Payer: Nomi Health Commercial |
$609.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.41
|
|
|
HC IR SIALOGRAM
|
Facility
|
OP
|
$594.95
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$490.54
|
| Rate for Payer: BCN Commercial |
$490.54
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$556.85
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$445.48
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC IR SIALOGRAM
|
Facility
|
IP
|
$594.95
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
32000025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.21 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Trust/PPO |
$488.57
|
| Rate for Payer: BCN Commercial |
$488.57
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
|
|
HC IR SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$1,492.33
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,119.25 |
| Max. Negotiated Rate |
$1,492.33 |
| Rate for Payer: Aetna Commercial |
$1,343.10
|
| Rate for Payer: Aetna Commercial |
$895.40
|
| Rate for Payer: ASR ASR |
$1,447.56
|
| Rate for Payer: ASR ASR |
$965.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$817.00
|
| Rate for Payer: BCN Commercial |
$1,225.50
|
| Rate for Payer: BCN Commercial |
$817.00
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cofinity Commercial |
$935.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.91
|
| Rate for Payer: Healthscope Commercial |
$1,447.56
|
| Rate for Payer: Healthscope Commercial |
$965.04
|
| Rate for Payer: Healthscope Whirlpool |
$994.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,492.33
|
| Rate for Payer: Mclaren Commercial |
$895.40
|
| Rate for Payer: Mclaren Commercial |
$1,343.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.48
|
| Rate for Payer: Nomi Health Commercial |
$815.81
|
| Rate for Payer: Nomi Health Commercial |
$1,223.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,313.25
|
|
|
HC IR SI JOINT NERVES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$1,492.33
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
36100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,492.33 |
| Rate for Payer: Aetna Commercial |
$1,343.10
|
| Rate for Payer: Aetna Commercial |
$895.40
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$1,447.56
|
| Rate for Payer: ASR ASR |
$965.04
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$820.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.43
|
| Rate for Payer: BCN Commercial |
$820.29
|
| Rate for Payer: BCN Commercial |
$1,230.43
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cash Price |
$1,193.86
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cash Price |
$795.91
|
| Rate for Payer: Cofinity Commercial |
$1,402.79
|
| Rate for Payer: Cofinity Commercial |
$935.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,447.56
|
| Rate for Payer: Healthscope Commercial |
$965.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,492.33
|
| Rate for Payer: Healthscope Whirlpool |
$994.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$895.40
|
| Rate for Payer: Mclaren Commercial |
$1,343.10
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.66
|
| Rate for Payer: Nomi Health Commercial |
$815.81
|
| Rate for Payer: Nomi Health Commercial |
$1,223.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.89
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$631.11
|
| Rate for Payer: Priority Health Narrow Network |
$631.11
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,313.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC IR SINAGRAM FISTULAGRAM
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.27 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
|
