|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,660.51
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$1,660.51 |
| Rate for Payer: Aetna Commercial |
$1,494.46
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$1,610.69
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.39
|
| Rate for Payer: BCCCP Commercial |
$656.55
|
| Rate for Payer: BCN Commercial |
$1,287.39
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,328.41
|
| Rate for Payer: Cash Price |
$1,328.41
|
| Rate for Payer: Cofinity Commercial |
$1,560.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,328.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$1,660.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,610.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$1,494.46
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,411.43
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.13
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$84.10
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,461.25
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,343.35
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$2,343.35 |
| Rate for Payer: Aetna Commercial |
$2,109.02
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$2,273.05
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.80
|
| Rate for Payer: BCCCP Commercial |
$268.69
|
| Rate for Payer: BCN Commercial |
$1,816.80
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,874.68
|
| Rate for Payer: Cash Price |
$1,874.68
|
| Rate for Payer: Cofinity Commercial |
$2,202.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$2,343.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,273.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$2,109.02
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,991.85
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.13
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$84.10
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,062.15
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
IP
|
$2,343.35
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,640.34 |
| Max. Negotiated Rate |
$2,343.35 |
| Rate for Payer: Aetna Commercial |
$2,109.02
|
| Rate for Payer: ASR ASR |
$2,273.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.80
|
| Rate for Payer: BCN Commercial |
$1,816.80
|
| Rate for Payer: Cash Price |
$1,874.68
|
| Rate for Payer: Cofinity Commercial |
$2,202.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.68
|
| Rate for Payer: Healthscope Commercial |
$2,343.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,273.05
|
| Rate for Payer: Mclaren Commercial |
$2,109.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,991.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,062.15
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$1,924.49
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,347.14 |
| Max. Negotiated Rate |
$1,924.49 |
| Rate for Payer: Aetna Commercial |
$1,732.04
|
| Rate for Payer: ASR ASR |
$1,866.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.06
|
| Rate for Payer: BCN Commercial |
$1,492.06
|
| Rate for Payer: Cash Price |
$1,539.59
|
| Rate for Payer: Cofinity Commercial |
$1,809.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.59
|
| Rate for Payer: Healthscope Commercial |
$1,924.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,866.76
|
| Rate for Payer: Mclaren Commercial |
$1,732.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,693.55
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$1,924.49
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$1,924.49 |
| Rate for Payer: Aetna Commercial |
$1,732.04
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$1,866.76
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.06
|
| Rate for Payer: BCCCP Commercial |
$382.11
|
| Rate for Payer: BCN Commercial |
$1,492.06
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,539.59
|
| Rate for Payer: Cash Price |
$1,539.59
|
| Rate for Payer: Cofinity Commercial |
$1,809.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$1,924.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,866.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$1,732.04
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.82
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.13
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$84.10
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,693.55
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,123.41
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,849.36 |
| Max. Negotiated Rate |
$7,123.41 |
| Rate for Payer: Aetna Commercial |
$6,411.07
|
| Rate for Payer: ASR ASR |
$6,909.71
|
| Rate for Payer: BCBS Complete |
$2,849.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,522.78
|
| Rate for Payer: BCN Commercial |
$5,522.78
|
| Rate for Payer: Cash Price |
$5,698.73
|
| Rate for Payer: Cofinity Commercial |
$6,696.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,698.73
|
| Rate for Payer: Healthscope Commercial |
$7,123.41
|
| Rate for Payer: Healthscope Whirlpool |
$6,909.71
|
| Rate for Payer: Mclaren Commercial |
$6,411.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,054.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,986.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,482.30
|
| Rate for Payer: Priority Health Narrow Network |
$5,057.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,268.60
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,123.41
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,986.39 |
| Max. Negotiated Rate |
$7,123.41 |
| Rate for Payer: Aetna Commercial |
$6,411.07
|
| Rate for Payer: ASR ASR |
$6,909.71
|
| Rate for Payer: BCBS Trust/PPO |
$5,522.78
|
| Rate for Payer: BCN Commercial |
$5,522.78
|
| Rate for Payer: Cash Price |
$5,698.73
|
| Rate for Payer: Cofinity Commercial |
$6,696.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,698.73
|
| Rate for Payer: Healthscope Commercial |
$7,123.41
|
| Rate for Payer: Healthscope Whirlpool |
$6,909.71
|
| Rate for Payer: Mclaren Commercial |
$6,411.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,054.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,986.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,268.60
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: ASR ASR |
$970.00
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS Trust/PPO |
$775.30
|
| Rate for Payer: BCN Commercial |
$775.30
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$940.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$1,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$970.00
|
| Rate for Payer: Mclaren Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.00
|
| Rate for Payer: Priority Health Narrow Network |
$710.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: ASR ASR |
$970.00
|
| Rate for Payer: BCBS Trust/PPO |
$775.30
|
| Rate for Payer: BCN Commercial |
$775.30
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$940.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$1,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$970.00
|
| Rate for Payer: Mclaren Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
OP
|
$828.96
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.58 |
| Max. Negotiated Rate |
$828.96 |
| Rate for Payer: Aetna Commercial |
$746.06
|
| Rate for Payer: ASR ASR |
$804.09
|
| Rate for Payer: BCBS Complete |
$331.58
|
| Rate for Payer: BCBS Trust/PPO |
$642.69
|
| Rate for Payer: BCN Commercial |
$642.69
|
| Rate for Payer: Cash Price |
$663.17
|
| Rate for Payer: Cofinity Commercial |
$779.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.17
|
| Rate for Payer: Healthscope Commercial |
$828.96
|
| Rate for Payer: Healthscope Whirlpool |
$804.09
|
| Rate for Payer: Mclaren Commercial |
$746.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$704.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.35
|
| Rate for Payer: Priority Health Narrow Network |
$588.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$729.48
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
IP
|
$828.96
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$580.27 |
| Max. Negotiated Rate |
$828.96 |
| Rate for Payer: Aetna Commercial |
$746.06
|
| Rate for Payer: ASR ASR |
$804.09
|
| Rate for Payer: BCBS Trust/PPO |
$642.69
|
| Rate for Payer: BCN Commercial |
$642.69
|
| Rate for Payer: Cash Price |
$663.17
|
| Rate for Payer: Cofinity Commercial |
$779.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.17
|
| Rate for Payer: Healthscope Commercial |
$828.96
|
| Rate for Payer: Healthscope Whirlpool |
$804.09
|
| Rate for Payer: Mclaren Commercial |
$746.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$704.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$729.48
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,100.84
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.34 |
| Max. Negotiated Rate |
$1,100.84 |
| Rate for Payer: Aetna Commercial |
$990.76
|
| Rate for Payer: ASR ASR |
$1,067.81
|
| Rate for Payer: BCBS Complete |
$440.34
|
| Rate for Payer: BCBS Trust/PPO |
$853.48
|
| Rate for Payer: BCN Commercial |
$853.48
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$1,034.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Healthscope Commercial |
$1,100.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.81
|
| Rate for Payer: Mclaren Commercial |
$990.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,001.76
|
| Rate for Payer: Priority Health Narrow Network |
$781.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.74
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,100.84
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$770.59 |
| Max. Negotiated Rate |
$1,100.84 |
| Rate for Payer: Aetna Commercial |
$990.76
|
| Rate for Payer: ASR ASR |
$1,067.81
|
| Rate for Payer: BCBS Trust/PPO |
$853.48
|
| Rate for Payer: BCN Commercial |
$853.48
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$1,034.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Healthscope Commercial |
$1,100.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.81
|
| Rate for Payer: Mclaren Commercial |
$990.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.74
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
OP
|
$10,241.99
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,096.80 |
| Max. Negotiated Rate |
$10,241.99 |
| Rate for Payer: Aetna Commercial |
$9,217.79
|
| Rate for Payer: ASR ASR |
$9,934.73
|
| Rate for Payer: BCBS Complete |
$4,096.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,940.61
|
| Rate for Payer: BCN Commercial |
$7,940.61
|
| Rate for Payer: Cash Price |
$8,193.59
|
| Rate for Payer: Cofinity Commercial |
$9,627.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,193.59
|
| Rate for Payer: Healthscope Commercial |
$10,241.99
|
| Rate for Payer: Healthscope Whirlpool |
$9,934.73
|
| Rate for Payer: Mclaren Commercial |
$9,217.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,705.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,169.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,320.21
|
| Rate for Payer: Priority Health Narrow Network |
$7,271.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,012.95
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
IP
|
$10,241.99
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,169.39 |
| Max. Negotiated Rate |
$10,241.99 |
| Rate for Payer: Aetna Commercial |
$9,217.79
|
| Rate for Payer: ASR ASR |
$9,934.73
|
| Rate for Payer: BCBS Trust/PPO |
$7,940.61
|
| Rate for Payer: BCN Commercial |
$7,940.61
|
| Rate for Payer: Cash Price |
$8,193.59
|
| Rate for Payer: Cofinity Commercial |
$9,627.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,193.59
|
| Rate for Payer: Healthscope Commercial |
$10,241.99
|
| Rate for Payer: Healthscope Whirlpool |
$9,934.73
|
| Rate for Payer: Mclaren Commercial |
$9,217.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,705.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,169.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,012.95
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Complete |
$400.30
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.69
|
| Rate for Payer: Priority Health Narrow Network |
$710.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$700.53 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
OP
|
$912.16
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.86 |
| Max. Negotiated Rate |
$912.16 |
| Rate for Payer: Aetna Commercial |
$820.94
|
| Rate for Payer: ASR ASR |
$884.80
|
| Rate for Payer: BCBS Complete |
$364.86
|
| Rate for Payer: BCBS Trust/PPO |
$707.20
|
| Rate for Payer: BCN Commercial |
$707.20
|
| Rate for Payer: Cash Price |
$729.73
|
| Rate for Payer: Cofinity Commercial |
$857.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.73
|
| Rate for Payer: Healthscope Commercial |
$912.16
|
| Rate for Payer: Healthscope Whirlpool |
$884.80
|
| Rate for Payer: Mclaren Commercial |
$820.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$775.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$830.07
|
| Rate for Payer: Priority Health Narrow Network |
$647.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.70
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
IP
|
$912.16
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$638.51 |
| Max. Negotiated Rate |
$912.16 |
| Rate for Payer: Aetna Commercial |
$820.94
|
| Rate for Payer: ASR ASR |
$884.80
|
| Rate for Payer: BCBS Trust/PPO |
$707.20
|
| Rate for Payer: BCN Commercial |
$707.20
|
| Rate for Payer: Cash Price |
$729.73
|
| Rate for Payer: Cofinity Commercial |
$857.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.73
|
| Rate for Payer: Healthscope Commercial |
$912.16
|
| Rate for Payer: Healthscope Whirlpool |
$884.80
|
| Rate for Payer: Mclaren Commercial |
$820.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$775.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.70
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
OP
|
$5,773.44
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,309.38 |
| Max. Negotiated Rate |
$5,773.44 |
| Rate for Payer: Aetna Commercial |
$5,196.10
|
| Rate for Payer: ASR ASR |
$5,600.24
|
| Rate for Payer: BCBS Complete |
$2,309.38
|
| Rate for Payer: BCBS Trust/PPO |
$4,476.15
|
| Rate for Payer: BCN Commercial |
$4,476.15
|
| Rate for Payer: Cash Price |
$4,618.75
|
| Rate for Payer: Cofinity Commercial |
$5,427.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,618.75
|
| Rate for Payer: Healthscope Commercial |
$5,773.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,600.24
|
| Rate for Payer: Mclaren Commercial |
$5,196.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,907.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,041.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,253.83
|
| Rate for Payer: Priority Health Narrow Network |
$4,099.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,080.63
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
IP
|
$5,773.44
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,041.41 |
| Max. Negotiated Rate |
$5,773.44 |
| Rate for Payer: Aetna Commercial |
$5,196.10
|
| Rate for Payer: ASR ASR |
$5,600.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,476.15
|
| Rate for Payer: BCN Commercial |
$4,476.15
|
| Rate for Payer: Cash Price |
$4,618.75
|
| Rate for Payer: Cofinity Commercial |
$5,427.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,618.75
|
| Rate for Payer: Healthscope Commercial |
$5,773.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,600.24
|
| Rate for Payer: Mclaren Commercial |
$5,196.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,907.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,041.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,080.63
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
IP
|
$5,409.65
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,786.76 |
| Max. Negotiated Rate |
$5,409.65 |
| Rate for Payer: Aetna Commercial |
$4,868.68
|
| Rate for Payer: ASR ASR |
$5,247.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,194.10
|
| Rate for Payer: BCN Commercial |
$4,194.10
|
| Rate for Payer: Cash Price |
$4,327.72
|
| Rate for Payer: Cofinity Commercial |
$5,085.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,327.72
|
| Rate for Payer: Healthscope Commercial |
$5,409.65
|
| Rate for Payer: Healthscope Whirlpool |
$5,247.36
|
| Rate for Payer: Mclaren Commercial |
$4,868.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,598.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,760.49
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
OP
|
$5,409.65
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,163.86 |
| Max. Negotiated Rate |
$5,409.65 |
| Rate for Payer: Aetna Commercial |
$4,868.68
|
| Rate for Payer: ASR ASR |
$5,247.36
|
| Rate for Payer: BCBS Complete |
$2,163.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,194.10
|
| Rate for Payer: BCN Commercial |
$4,194.10
|
| Rate for Payer: Cash Price |
$4,327.72
|
| Rate for Payer: Cofinity Commercial |
$5,085.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,327.72
|
| Rate for Payer: Healthscope Commercial |
$5,409.65
|
| Rate for Payer: Healthscope Whirlpool |
$5,247.36
|
| Rate for Payer: Mclaren Commercial |
$4,868.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,598.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,922.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,840.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,760.49
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
IP
|
$3,282.56
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,297.79 |
| Max. Negotiated Rate |
$3,282.56 |
| Rate for Payer: Aetna Commercial |
$2,954.30
|
| Rate for Payer: ASR ASR |
$3,184.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,544.97
|
| Rate for Payer: BCN Commercial |
$2,544.97
|
| Rate for Payer: Cash Price |
$2,626.05
|
| Rate for Payer: Cofinity Commercial |
$3,085.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.05
|
| Rate for Payer: Healthscope Commercial |
$3,282.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,184.08
|
| Rate for Payer: Mclaren Commercial |
$2,954.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,790.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,297.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,888.65
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$3,282.56
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$990.33 |
| Max. Negotiated Rate |
$3,282.56 |
| Rate for Payer: Aetna Commercial |
$2,954.30
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$3,184.08
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,544.97
|
| Rate for Payer: BCN Commercial |
$2,544.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$2,626.05
|
| Rate for Payer: Cash Price |
$2,626.05
|
| Rate for Payer: Cofinity Commercial |
$3,085.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$3,282.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,184.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$2,954.30
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,790.18
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,297.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,987.13
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,330.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,888.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
