|
HC IR MYELOGRAM THORACIC
|
Facility
|
IP
|
$1,013.15
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$658.55 |
| Max. Negotiated Rate |
$1,013.15 |
| Rate for Payer: Aetna Commercial |
$911.84
|
| Rate for Payer: ASR ASR |
$982.76
|
| Rate for Payer: ASR Commercial |
$982.76
|
| Rate for Payer: BCBS Trust/PPO |
$825.62
|
| Rate for Payer: BCN Commercial |
$785.50
|
| Rate for Payer: Cash Price |
$810.52
|
| Rate for Payer: Cofinity Commercial |
$952.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.52
|
| Rate for Payer: Healthscope Commercial |
$1,013.15
|
| Rate for Payer: Healthscope Whirlpool |
$982.76
|
| Rate for Payer: Mclaren Commercial |
$911.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.18
|
| Rate for Payer: Nomi Health Commercial |
$830.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.57
|
|
|
HC IR MYELOGRAM THORACIC
|
Facility
|
OP
|
$1,013.15
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,194.32 |
| Rate for Payer: Aetna Commercial |
$911.84
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$982.76
|
| Rate for Payer: ASR Commercial |
$982.76
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$829.67
|
| Rate for Payer: BCN Commercial |
$785.50
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$810.52
|
| Rate for Payer: Cash Price |
$810.52
|
| Rate for Payer: Cofinity Commercial |
$952.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,013.15
|
| Rate for Payer: Healthscope Whirlpool |
$982.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$911.84
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.18
|
| Rate for Payer: Nomi Health Commercial |
$830.78
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$887.72
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$710.22
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC IR MYELOGRAM TWO OR MORE REGIO
|
Facility
|
OP
|
$1,360.85
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
32000056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Aetna Commercial |
$1,224.77
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$1,320.02
|
| Rate for Payer: ASR Commercial |
$1,320.02
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.40
|
| Rate for Payer: BCN Commercial |
$1,055.07
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,279.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,360.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,224.77
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,115.90
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.38
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$953.96
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC IR MYELOGRAM TWO OR MORE REGIO
|
Facility
|
IP
|
$1,360.85
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
32000056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$884.55 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Aetna Commercial |
$1,224.77
|
| Rate for Payer: ASR ASR |
$1,320.02
|
| Rate for Payer: ASR Commercial |
$1,320.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.96
|
| Rate for Payer: BCN Commercial |
$1,055.07
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,279.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Healthscope Commercial |
$1,360.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.02
|
| Rate for Payer: Mclaren Commercial |
$1,224.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,115.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.55
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
30100268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: ASR ASR |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Trust/PPO |
$37.43
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
30100268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$8.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.93
|
| Rate for Payer: ASR ASR |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS MAPPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$37.61
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.74
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Mclaren Medicare |
$8.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.18
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: PACE Medicare |
$8.30
|
| Rate for Payer: PACE SWMI |
$8.74
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Medicaid |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$8.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.24
|
| Rate for Payer: Priority Health Medicare |
$8.74
|
| Rate for Payer: Priority Health Narrow Network |
$32.20
|
| Rate for Payer: Railroad Medicare Medicare |
$8.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.74
|
| Rate for Payer: UHC Exchange |
$13.55
|
| Rate for Payer: UHC Medicare Advantage |
$8.74
|
| Rate for Payer: UHCCP DNSP |
$8.74
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$8.74
|
|
|
HC IRON LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
30100267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP DNSP |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC IRON LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
30100267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
IP
|
$576.25
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$576.25 |
| Rate for Payer: Aetna Commercial |
$518.62
|
| Rate for Payer: ASR ASR |
$558.96
|
| Rate for Payer: ASR Commercial |
$558.96
|
| Rate for Payer: BCBS Trust/PPO |
$469.59
|
| Rate for Payer: BCN Commercial |
$446.77
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cofinity Commercial |
$541.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.00
|
| Rate for Payer: Healthscope Commercial |
$576.25
|
| Rate for Payer: Healthscope Whirlpool |
$558.96
|
| Rate for Payer: Mclaren Commercial |
$518.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.81
|
| Rate for Payer: Nomi Health Commercial |
$472.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.10
|
|
|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
OP
|
$576.25
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.50 |
| Max. Negotiated Rate |
$576.25 |
| Rate for Payer: Aetna Commercial |
$518.62
|
| Rate for Payer: Aetna Medicare |
$288.12
|
| Rate for Payer: ASR ASR |
$558.96
|
| Rate for Payer: ASR Commercial |
$558.96
|
| Rate for Payer: BCBS Complete |
$230.50
|
| Rate for Payer: BCBS Trust/PPO |
$471.89
|
| Rate for Payer: BCN Commercial |
$446.77
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cofinity Commercial |
$541.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.00
|
| Rate for Payer: Healthscope Commercial |
$576.25
|
| Rate for Payer: Healthscope Whirlpool |
$558.96
|
| Rate for Payer: Mclaren Commercial |
$518.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.81
|
| Rate for Payer: Nomi Health Commercial |
$472.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.91
|
| Rate for Payer: Priority Health Narrow Network |
$403.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.10
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
OP
|
$11,637.37
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,654.95 |
| Max. Negotiated Rate |
$11,637.37 |
| Rate for Payer: Aetna Commercial |
$10,473.63
|
| Rate for Payer: Aetna Medicare |
$5,818.69
|
| Rate for Payer: ASR ASR |
$11,288.25
|
| Rate for Payer: ASR Commercial |
$11,288.25
|
| Rate for Payer: BCBS Complete |
$4,654.95
|
| Rate for Payer: BCBS Trust/PPO |
$9,529.84
|
| Rate for Payer: BCN Commercial |
$9,022.45
|
| Rate for Payer: Cash Price |
$9,309.90
|
| Rate for Payer: Cofinity Commercial |
$10,939.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,309.90
|
| Rate for Payer: Healthscope Commercial |
$11,637.37
|
| Rate for Payer: Healthscope Whirlpool |
$11,288.25
|
| Rate for Payer: Mclaren Commercial |
$10,473.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,891.76
|
| Rate for Payer: Nomi Health Commercial |
$9,542.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,564.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,196.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,157.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,240.89
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
IP
|
$11,637.37
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,564.29 |
| Max. Negotiated Rate |
$11,637.37 |
| Rate for Payer: Aetna Commercial |
$10,473.63
|
| Rate for Payer: ASR ASR |
$11,288.25
|
| Rate for Payer: ASR Commercial |
$11,288.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,483.29
|
| Rate for Payer: BCN Commercial |
$9,022.45
|
| Rate for Payer: Cash Price |
$9,309.90
|
| Rate for Payer: Cofinity Commercial |
$10,939.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,309.90
|
| Rate for Payer: Healthscope Commercial |
$11,637.37
|
| Rate for Payer: Healthscope Whirlpool |
$11,288.25
|
| Rate for Payer: Mclaren Commercial |
$10,473.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,891.76
|
| Rate for Payer: Nomi Health Commercial |
$9,542.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,564.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,240.89
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
OP
|
$3,457.60
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,383.04 |
| Max. Negotiated Rate |
$3,457.60 |
| Rate for Payer: Aetna Commercial |
$3,111.84
|
| Rate for Payer: Aetna Medicare |
$1,728.80
|
| Rate for Payer: ASR ASR |
$3,353.87
|
| Rate for Payer: ASR Commercial |
$3,353.87
|
| Rate for Payer: BCBS Complete |
$1,383.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,831.43
|
| Rate for Payer: BCN Commercial |
$2,680.68
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cofinity Commercial |
$3,250.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,766.08
|
| Rate for Payer: Healthscope Commercial |
$3,457.60
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.87
|
| Rate for Payer: Mclaren Commercial |
$3,111.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,938.96
|
| Rate for Payer: Nomi Health Commercial |
$2,835.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,029.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,423.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,042.69
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
IP
|
$3,457.60
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,247.44 |
| Max. Negotiated Rate |
$3,457.60 |
| Rate for Payer: Aetna Commercial |
$3,111.84
|
| Rate for Payer: ASR ASR |
$3,353.87
|
| Rate for Payer: ASR Commercial |
$3,353.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,817.60
|
| Rate for Payer: BCN Commercial |
$2,680.68
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cofinity Commercial |
$3,250.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,766.08
|
| Rate for Payer: Healthscope Commercial |
$3,457.60
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.87
|
| Rate for Payer: Mclaren Commercial |
$3,111.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,938.96
|
| Rate for Payer: Nomi Health Commercial |
$2,835.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,042.69
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
OP
|
$5,401.96
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,160.78 |
| Max. Negotiated Rate |
$5,401.96 |
| Rate for Payer: Aetna Commercial |
$4,861.76
|
| Rate for Payer: Aetna Medicare |
$2,700.98
|
| Rate for Payer: ASR ASR |
$5,239.90
|
| Rate for Payer: ASR Commercial |
$5,239.90
|
| Rate for Payer: BCBS Complete |
$2,160.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,423.67
|
| Rate for Payer: BCN Commercial |
$4,188.14
|
| Rate for Payer: Cash Price |
$4,321.57
|
| Rate for Payer: Cofinity Commercial |
$5,077.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,321.57
|
| Rate for Payer: Healthscope Commercial |
$5,401.96
|
| Rate for Payer: Healthscope Whirlpool |
$5,239.90
|
| Rate for Payer: Mclaren Commercial |
$4,861.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,591.67
|
| Rate for Payer: Nomi Health Commercial |
$4,429.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,511.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,733.20
|
| Rate for Payer: Priority Health Narrow Network |
$3,786.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,753.72
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
IP
|
$5,401.96
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,511.27 |
| Max. Negotiated Rate |
$5,401.96 |
| Rate for Payer: Aetna Commercial |
$4,861.76
|
| Rate for Payer: ASR ASR |
$5,239.90
|
| Rate for Payer: ASR Commercial |
$5,239.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,402.06
|
| Rate for Payer: BCN Commercial |
$4,188.14
|
| Rate for Payer: Cash Price |
$4,321.57
|
| Rate for Payer: Cofinity Commercial |
$5,077.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,321.57
|
| Rate for Payer: Healthscope Commercial |
$5,401.96
|
| Rate for Payer: Healthscope Whirlpool |
$5,239.90
|
| Rate for Payer: Mclaren Commercial |
$4,861.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,591.67
|
| Rate for Payer: Nomi Health Commercial |
$4,429.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,511.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,753.72
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
OP
|
$10,281.82
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,112.73 |
| Max. Negotiated Rate |
$10,281.82 |
| Rate for Payer: Aetna Commercial |
$9,253.64
|
| Rate for Payer: Aetna Medicare |
$5,140.91
|
| Rate for Payer: ASR ASR |
$9,973.37
|
| Rate for Payer: ASR Commercial |
$9,973.37
|
| Rate for Payer: BCBS Complete |
$4,112.73
|
| Rate for Payer: BCBS Trust/PPO |
$8,419.78
|
| Rate for Payer: BCN Commercial |
$7,971.50
|
| Rate for Payer: Cash Price |
$8,225.46
|
| Rate for Payer: Cofinity Commercial |
$9,664.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,225.46
|
| Rate for Payer: Healthscope Commercial |
$10,281.82
|
| Rate for Payer: Healthscope Whirlpool |
$9,973.37
|
| Rate for Payer: Mclaren Commercial |
$9,253.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,739.55
|
| Rate for Payer: Nomi Health Commercial |
$8,431.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,683.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,008.93
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,048.00
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
IP
|
$10,281.82
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,683.18 |
| Max. Negotiated Rate |
$10,281.82 |
| Rate for Payer: Aetna Commercial |
$9,253.64
|
| Rate for Payer: ASR ASR |
$9,973.37
|
| Rate for Payer: ASR Commercial |
$9,973.37
|
| Rate for Payer: BCBS Trust/PPO |
$8,378.66
|
| Rate for Payer: BCN Commercial |
$7,971.50
|
| Rate for Payer: Cash Price |
$8,225.46
|
| Rate for Payer: Cofinity Commercial |
$9,664.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,225.46
|
| Rate for Payer: Healthscope Commercial |
$10,281.82
|
| Rate for Payer: Healthscope Whirlpool |
$9,973.37
|
| Rate for Payer: Mclaren Commercial |
$9,253.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,739.55
|
| Rate for Payer: Nomi Health Commercial |
$8,431.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,683.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,048.00
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
IP
|
$10,281.82
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,683.18 |
| Max. Negotiated Rate |
$10,281.82 |
| Rate for Payer: Aetna Commercial |
$9,253.64
|
| Rate for Payer: ASR ASR |
$9,973.37
|
| Rate for Payer: ASR Commercial |
$9,973.37
|
| Rate for Payer: BCBS Trust/PPO |
$8,378.66
|
| Rate for Payer: BCN Commercial |
$7,971.50
|
| Rate for Payer: Cash Price |
$8,225.46
|
| Rate for Payer: Cofinity Commercial |
$9,664.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,225.46
|
| Rate for Payer: Healthscope Commercial |
$10,281.82
|
| Rate for Payer: Healthscope Whirlpool |
$9,973.37
|
| Rate for Payer: Mclaren Commercial |
$9,253.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,739.55
|
| Rate for Payer: Nomi Health Commercial |
$8,431.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,683.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,048.00
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
OP
|
$10,281.82
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,112.73 |
| Max. Negotiated Rate |
$10,281.82 |
| Rate for Payer: Aetna Commercial |
$9,253.64
|
| Rate for Payer: Aetna Medicare |
$5,140.91
|
| Rate for Payer: ASR ASR |
$9,973.37
|
| Rate for Payer: ASR Commercial |
$9,973.37
|
| Rate for Payer: BCBS Complete |
$4,112.73
|
| Rate for Payer: BCBS Trust/PPO |
$8,419.78
|
| Rate for Payer: BCN Commercial |
$7,971.50
|
| Rate for Payer: Cash Price |
$8,225.46
|
| Rate for Payer: Cofinity Commercial |
$9,664.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,225.46
|
| Rate for Payer: Healthscope Commercial |
$10,281.82
|
| Rate for Payer: Healthscope Whirlpool |
$9,973.37
|
| Rate for Payer: Mclaren Commercial |
$9,253.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,739.55
|
| Rate for Payer: Nomi Health Commercial |
$8,431.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,683.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,008.93
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,048.00
|
|
|
HC IR PULMONARY
|
Facility
|
OP
|
$2,010.44
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
32000195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,306.79 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$1,809.40
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$1,950.13
|
| Rate for Payer: ASR Commercial |
$1,950.13
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.35
|
| Rate for Payer: BCN Commercial |
$1,558.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$1,608.35
|
| Rate for Payer: Cash Price |
$1,608.35
|
| Rate for Payer: Cofinity Commercial |
$1,889.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,950.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$1,809.40
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,708.87
|
| Rate for Payer: Nomi Health Commercial |
$1,648.56
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.55
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,409.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,769.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC IR PULMONARY
|
Facility
|
IP
|
$2,010.44
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
32000195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,306.79 |
| Max. Negotiated Rate |
$2,010.44 |
| Rate for Payer: Aetna Commercial |
$1,809.40
|
| Rate for Payer: ASR ASR |
$1,950.13
|
| Rate for Payer: ASR Commercial |
$1,950.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,638.31
|
| Rate for Payer: BCN Commercial |
$1,558.69
|
| Rate for Payer: Cash Price |
$1,608.35
|
| Rate for Payer: Cofinity Commercial |
$1,889.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.35
|
| Rate for Payer: Healthscope Commercial |
$2,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,950.13
|
| Rate for Payer: Mclaren Commercial |
$1,809.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,708.87
|
| Rate for Payer: Nomi Health Commercial |
$1,648.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,769.19
|
|
|
HC IR PULMONARY BILATERAL
|
Facility
|
IP
|
$3,499.53
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
32000196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,274.69 |
| Max. Negotiated Rate |
$3,499.53 |
| Rate for Payer: Aetna Commercial |
$3,149.58
|
| Rate for Payer: ASR ASR |
$3,394.54
|
| Rate for Payer: ASR Commercial |
$3,394.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,851.77
|
| Rate for Payer: BCN Commercial |
$2,713.19
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cofinity Commercial |
$3,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.62
|
| Rate for Payer: Healthscope Commercial |
$3,499.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,394.54
|
| Rate for Payer: Mclaren Commercial |
$3,149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.60
|
| Rate for Payer: Nomi Health Commercial |
$2,869.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,274.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,079.59
|
|
|
HC IR PULMONARY BILATERAL
|
Facility
|
OP
|
$3,499.53
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
32000196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,149.58
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,394.54
|
| Rate for Payer: ASR Commercial |
$3,394.54
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,865.77
|
| Rate for Payer: BCN Commercial |
$2,713.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cash Price |
$2,799.62
|
| Rate for Payer: Cofinity Commercial |
$3,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,499.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,394.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,149.58
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.60
|
| Rate for Payer: Nomi Health Commercial |
$2,869.61
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,274.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,066.29
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,453.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,079.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC IRRADIATION BLOOD PROD-EA UNIT
|
Facility
|
OP
|
$123.73
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
39000026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$123.73 |
| Rate for Payer: Aetna Commercial |
$111.36
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$120.02
|
| Rate for Payer: ASR Commercial |
$120.02
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$101.32
|
| Rate for Payer: BCN Commercial |
$95.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$123.73
|
| Rate for Payer: Healthscope Whirlpool |
$120.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$111.36
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.17
|
| Rate for Payer: Nomi Health Commercial |
$101.46
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.41
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$86.73
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
