HC VEIN MAPPING UNILAT UPPER EXTREMITY (R OR L)
|
Facility
|
IP
|
$850.62
|
|
Service Code
|
CPT 93971
|
Hospital Charge Code |
92100029
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$595.43 |
Max. Negotiated Rate |
$850.62 |
Rate for Payer: Aetna Commercial |
$765.56
|
Rate for Payer: ASR ASR |
$825.10
|
Rate for Payer: BCBS Trust/PPO |
$659.49
|
Rate for Payer: BCN Commercial |
$659.49
|
Rate for Payer: Cash Price |
$680.50
|
Rate for Payer: Cofinity Commercial |
$799.58
|
Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
Rate for Payer: Healthscope Commercial |
$850.62
|
Rate for Payer: Healthscope Whirlpool |
$825.10
|
Rate for Payer: Mclaren Commercial |
$765.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.55
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
OP
|
$2,365.65
|
|
Service Code
|
HCPCS c1880
|
Hospital Charge Code |
27800093
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$946.26 |
Max. Negotiated Rate |
$2,365.65 |
Rate for Payer: Aetna Commercial |
$2,129.08
|
Rate for Payer: ASR ASR |
$2,294.68
|
Rate for Payer: BCBS Complete |
$946.26
|
Rate for Payer: BCBS Trust/PPO |
$1,834.09
|
Rate for Payer: BCN Commercial |
$1,834.09
|
Rate for Payer: Cash Price |
$1,892.52
|
Rate for Payer: Cofinity Commercial |
$2,223.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.52
|
Rate for Payer: Healthscope Commercial |
$2,365.65
|
Rate for Payer: Healthscope Whirlpool |
$2,294.68
|
Rate for Payer: Mclaren Commercial |
$2,129.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,010.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,655.96
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,152.74
|
Rate for Payer: Priority Health Narrow Network |
$1,679.61
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,081.77
|
|
HC VENA CAVA FILTER LVL 5
|
Facility
|
IP
|
$2,365.65
|
|
Service Code
|
HCPCS c1880
|
Hospital Charge Code |
27800093
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,655.96 |
Max. Negotiated Rate |
$2,365.65 |
Rate for Payer: Aetna Commercial |
$2,129.08
|
Rate for Payer: ASR ASR |
$2,294.68
|
Rate for Payer: BCBS Trust/PPO |
$1,834.09
|
Rate for Payer: BCN Commercial |
$1,834.09
|
Rate for Payer: Cash Price |
$1,892.52
|
Rate for Payer: Cofinity Commercial |
$2,223.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.52
|
Rate for Payer: Healthscope Commercial |
$2,365.65
|
Rate for Payer: Healthscope Whirlpool |
$2,294.68
|
Rate for Payer: Mclaren Commercial |
$2,129.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,010.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,655.96
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,081.77
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
OP
|
$2,890.65
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
27800094
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,156.26 |
Max. Negotiated Rate |
$2,890.65 |
Rate for Payer: Aetna Commercial |
$2,601.58
|
Rate for Payer: ASR ASR |
$2,803.93
|
Rate for Payer: BCBS Complete |
$1,156.26
|
Rate for Payer: BCBS Trust/PPO |
$2,241.12
|
Rate for Payer: BCN Commercial |
$2,241.12
|
Rate for Payer: Cash Price |
$2,312.52
|
Rate for Payer: Cofinity Commercial |
$2,717.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2,312.52
|
Rate for Payer: Healthscope Commercial |
$2,890.65
|
Rate for Payer: Healthscope Whirlpool |
$2,803.93
|
Rate for Payer: Mclaren Commercial |
$2,601.58
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,457.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,023.46
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,630.49
|
Rate for Payer: Priority Health Narrow Network |
$2,052.36
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,543.77
|
|
HC VENA CAVA FILTER LVL 6
|
Facility
|
IP
|
$2,890.65
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
27800094
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,023.46 |
Max. Negotiated Rate |
$2,890.65 |
Rate for Payer: Aetna Commercial |
$2,601.58
|
Rate for Payer: ASR ASR |
$2,803.93
|
Rate for Payer: BCBS Trust/PPO |
$2,241.12
|
Rate for Payer: BCN Commercial |
$2,241.12
|
Rate for Payer: Cash Price |
$2,312.52
|
Rate for Payer: Cofinity Commercial |
$2,717.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2,312.52
|
Rate for Payer: Healthscope Commercial |
$2,890.65
|
Rate for Payer: Healthscope Whirlpool |
$2,803.93
|
Rate for Payer: Mclaren Commercial |
$2,601.58
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,457.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,023.46
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,543.77
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
OP
|
$400.07
|
|
Hospital Charge Code |
36000051
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$160.03 |
Max. Negotiated Rate |
$400.07 |
Rate for Payer: Aetna Commercial |
$360.06
|
Rate for Payer: ASR ASR |
$388.07
|
Rate for Payer: BCBS Complete |
$160.03
|
Rate for Payer: BCBS Trust/PPO |
$310.17
|
Rate for Payer: BCN Commercial |
$310.17
|
Rate for Payer: Cash Price |
$320.06
|
Rate for Payer: Cofinity Commercial |
$376.07
|
Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
Rate for Payer: Healthscope Commercial |
$400.07
|
Rate for Payer: Healthscope Whirlpool |
$388.07
|
Rate for Payer: Mclaren Commercial |
$360.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.06
|
Rate for Payer: Priority Health Narrow Network |
$284.05
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.06
|
|
HC VEN ADDL VEIN INTRAOP
|
Facility
|
IP
|
$400.07
|
|
Hospital Charge Code |
36000051
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$280.05 |
Max. Negotiated Rate |
$400.07 |
Rate for Payer: Aetna Commercial |
$360.06
|
Rate for Payer: ASR ASR |
$388.07
|
Rate for Payer: BCBS Trust/PPO |
$310.17
|
Rate for Payer: BCN Commercial |
$310.17
|
Rate for Payer: Cash Price |
$320.06
|
Rate for Payer: Cofinity Commercial |
$376.07
|
Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
Rate for Payer: Healthscope Commercial |
$400.07
|
Rate for Payer: Healthscope Whirlpool |
$388.07
|
Rate for Payer: Mclaren Commercial |
$360.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.06
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
IP
|
$45.00
|
|
Service Code
|
CPT 36410
|
Hospital Charge Code |
45000105
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$31.50 |
Max. Negotiated Rate |
$45.00 |
Rate for Payer: Aetna Commercial |
$40.50
|
Rate for Payer: ASR ASR |
$43.65
|
Rate for Payer: BCBS Trust/PPO |
$34.89
|
Rate for Payer: BCN Commercial |
$34.89
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Cofinity Commercial |
$42.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
Rate for Payer: Healthscope Commercial |
$45.00
|
Rate for Payer: Healthscope Whirlpool |
$43.65
|
Rate for Payer: Mclaren Commercial |
$40.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
HC VENIPUNCT BY PHYS/QHP 3/> YRS
|
Facility
|
OP
|
$45.00
|
|
Service Code
|
CPT 36410
|
Hospital Charge Code |
45000105
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$18.00 |
Max. Negotiated Rate |
$45.00 |
Rate for Payer: Aetna Commercial |
$40.50
|
Rate for Payer: ASR ASR |
$43.65
|
Rate for Payer: BCBS Complete |
$18.00
|
Rate for Payer: BCBS Trust/PPO |
$34.89
|
Rate for Payer: BCN Commercial |
$34.89
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Cofinity Commercial |
$42.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
Rate for Payer: Healthscope Commercial |
$45.00
|
Rate for Payer: Healthscope Whirlpool |
$43.65
|
Rate for Payer: Mclaren Commercial |
$40.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
Rate for Payer: Priority Health Narrow Network |
$26.27
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
HC VENOGRAM ADRENAL
|
Facility
|
IP
|
$8,645.04
|
|
Service Code
|
CPT 75840
|
Hospital Charge Code |
32000334
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$6,051.53 |
Max. Negotiated Rate |
$8,645.04 |
Rate for Payer: Aetna Commercial |
$7,780.54
|
Rate for Payer: ASR ASR |
$8,385.69
|
Rate for Payer: BCBS Trust/PPO |
$6,702.50
|
Rate for Payer: BCN Commercial |
$6,702.50
|
Rate for Payer: Cash Price |
$6,916.03
|
Rate for Payer: Cofinity Commercial |
$8,126.34
|
Rate for Payer: Encore Health Key Benefits Commercial |
$6,916.03
|
Rate for Payer: Healthscope Commercial |
$8,645.04
|
Rate for Payer: Healthscope Whirlpool |
$8,385.69
|
Rate for Payer: Mclaren Commercial |
$7,780.54
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,348.28
|
Rate for Payer: Priority Health Cigna Priority Health |
$6,051.53
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,607.64
|
|
HC VENOGRAM ADRENAL
|
Facility
|
OP
|
$8,645.04
|
|
Service Code
|
CPT 75840
|
Hospital Charge Code |
32000334
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$1,549.81 |
Max. Negotiated Rate |
$8,645.04 |
Rate for Payer: Aetna Commercial |
$7,780.54
|
Rate for Payer: Aetna Medicare |
$2,833.29
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
Rate for Payer: ASR ASR |
$8,385.69
|
Rate for Payer: BCBS Complete |
$1,627.44
|
Rate for Payer: BCBS MAPPO |
$2,833.29
|
Rate for Payer: BCBS Trust/PPO |
$6,702.50
|
Rate for Payer: BCN Commercial |
$6,702.50
|
Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
Rate for Payer: Cash Price |
$6,916.03
|
Rate for Payer: Cash Price |
$6,916.03
|
Rate for Payer: Cofinity Commercial |
$8,126.34
|
Rate for Payer: Encore Health Key Benefits Commercial |
$6,916.03
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
Rate for Payer: Healthscope Commercial |
$8,645.04
|
Rate for Payer: Healthscope Whirlpool |
$8,385.69
|
Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
Rate for Payer: Mclaren Commercial |
$7,780.54
|
Rate for Payer: Mclaren Medicaid |
$1,549.81
|
Rate for Payer: Mclaren Medicare |
$2,833.29
|
Rate for Payer: Meridian Medicaid |
$1,627.44
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,348.28
|
Rate for Payer: PACE Medicare |
$2,691.63
|
Rate for Payer: PACE SWMI |
$2,833.29
|
Rate for Payer: PHP Commercial |
$3,116.62
|
Rate for Payer: PHP Medicaid |
$1,549.81
|
Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
Rate for Payer: Priority Health Cigna Priority Health |
$6,051.53
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,866.99
|
Rate for Payer: Priority Health Medicare |
$2,833.29
|
Rate for Payer: Priority Health Narrow Network |
$6,137.98
|
Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,607.64
|
Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
Rate for Payer: VA VA |
$2,833.29
|
|
HC VENOGRAM INTERNAL JUGULAR
|
Facility
|
OP
|
$4,919.81
|
|
Service Code
|
CPT 75860
|
Hospital Charge Code |
32000319
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$1,549.81 |
Max. Negotiated Rate |
$4,919.81 |
Rate for Payer: Aetna Commercial |
$4,427.83
|
Rate for Payer: Aetna Medicare |
$2,833.29
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
Rate for Payer: ASR ASR |
$4,772.22
|
Rate for Payer: BCBS Complete |
$1,627.44
|
Rate for Payer: BCBS MAPPO |
$2,833.29
|
Rate for Payer: BCBS Trust/PPO |
$3,814.33
|
Rate for Payer: BCN Commercial |
$3,814.33
|
Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
Rate for Payer: Cash Price |
$3,935.85
|
Rate for Payer: Cash Price |
$3,935.85
|
Rate for Payer: Cofinity Commercial |
$4,624.62
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3,935.85
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
Rate for Payer: Healthscope Commercial |
$4,919.81
|
Rate for Payer: Healthscope Whirlpool |
$4,772.22
|
Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
Rate for Payer: Mclaren Commercial |
$4,427.83
|
Rate for Payer: Mclaren Medicaid |
$1,549.81
|
Rate for Payer: Mclaren Medicare |
$2,833.29
|
Rate for Payer: Meridian Medicaid |
$1,627.44
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,181.84
|
Rate for Payer: PACE Medicare |
$2,691.63
|
Rate for Payer: PACE SWMI |
$2,833.29
|
Rate for Payer: PHP Commercial |
$3,116.62
|
Rate for Payer: PHP Medicaid |
$1,549.81
|
Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,443.87
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,477.03
|
Rate for Payer: Priority Health Medicare |
$2,833.29
|
Rate for Payer: Priority Health Narrow Network |
$3,493.07
|
Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,329.43
|
Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
Rate for Payer: VA VA |
$2,833.29
|
|
HC VENOGRAM INTERNAL JUGULAR
|
Facility
|
IP
|
$4,919.81
|
|
Service Code
|
CPT 75860
|
Hospital Charge Code |
32000319
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$3,443.87 |
Max. Negotiated Rate |
$4,919.81 |
Rate for Payer: Aetna Commercial |
$4,427.83
|
Rate for Payer: ASR ASR |
$4,772.22
|
Rate for Payer: BCBS Trust/PPO |
$3,814.33
|
Rate for Payer: BCN Commercial |
$3,814.33
|
Rate for Payer: Cash Price |
$3,935.85
|
Rate for Payer: Cofinity Commercial |
$4,624.62
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3,935.85
|
Rate for Payer: Healthscope Commercial |
$4,919.81
|
Rate for Payer: Healthscope Whirlpool |
$4,772.22
|
Rate for Payer: Mclaren Commercial |
$4,427.83
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,181.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,443.87
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,329.43
|
|
HC VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
IP
|
$2,394.47
|
|
Service Code
|
CPT 75870
|
Hospital Charge Code |
32000320
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$1,676.13 |
Max. Negotiated Rate |
$2,394.47 |
Rate for Payer: Aetna Commercial |
$2,155.02
|
Rate for Payer: ASR ASR |
$2,322.64
|
Rate for Payer: BCBS Trust/PPO |
$1,856.43
|
Rate for Payer: BCN Commercial |
$1,856.43
|
Rate for Payer: Cash Price |
$1,915.58
|
Rate for Payer: Cofinity Commercial |
$2,250.80
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,915.58
|
Rate for Payer: Healthscope Commercial |
$2,394.47
|
Rate for Payer: Healthscope Whirlpool |
$2,322.64
|
Rate for Payer: Mclaren Commercial |
$2,155.02
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,035.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,676.13
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,107.13
|
|
HC VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
OP
|
$2,394.47
|
|
Service Code
|
CPT 75870
|
Hospital Charge Code |
32000320
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$1,549.81 |
Max. Negotiated Rate |
$3,541.61 |
Rate for Payer: Aetna Commercial |
$2,155.02
|
Rate for Payer: Aetna Medicare |
$2,833.29
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
Rate for Payer: ASR ASR |
$2,322.64
|
Rate for Payer: BCBS Complete |
$1,627.44
|
Rate for Payer: BCBS MAPPO |
$2,833.29
|
Rate for Payer: BCBS Trust/PPO |
$1,856.43
|
Rate for Payer: BCN Commercial |
$1,856.43
|
Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
Rate for Payer: Cash Price |
$1,915.58
|
Rate for Payer: Cash Price |
$1,915.58
|
Rate for Payer: Cofinity Commercial |
$2,250.80
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,915.58
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
Rate for Payer: Healthscope Commercial |
$2,394.47
|
Rate for Payer: Healthscope Whirlpool |
$2,322.64
|
Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
Rate for Payer: Mclaren Commercial |
$2,155.02
|
Rate for Payer: Mclaren Medicaid |
$1,549.81
|
Rate for Payer: Mclaren Medicare |
$2,833.29
|
Rate for Payer: Meridian Medicaid |
$1,627.44
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,035.30
|
Rate for Payer: PACE Medicare |
$2,691.63
|
Rate for Payer: PACE SWMI |
$2,833.29
|
Rate for Payer: PHP Commercial |
$3,116.62
|
Rate for Payer: PHP Medicaid |
$1,549.81
|
Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,676.13
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,178.97
|
Rate for Payer: Priority Health Medicare |
$2,833.29
|
Rate for Payer: Priority Health Narrow Network |
$1,700.07
|
Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,107.13
|
Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
Rate for Payer: VA VA |
$2,833.29
|
|
HC VENOUS INSUFFICIENCY BIL
|
Facility
|
OP
|
$1,760.88
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92000033
|
Hospital Revenue Code
|
920
|
Min. Negotiated Rate |
$119.14 |
Max. Negotiated Rate |
$1,760.88 |
Rate for Payer: Aetna Commercial |
$1,584.79
|
Rate for Payer: Aetna Medicare |
$217.81
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
Rate for Payer: ASR ASR |
$1,708.05
|
Rate for Payer: BCBS Complete |
$125.11
|
Rate for Payer: BCBS MAPPO |
$217.81
|
Rate for Payer: BCBS Trust/PPO |
$1,365.21
|
Rate for Payer: BCN Commercial |
$1,365.21
|
Rate for Payer: BCN Medicare Advantage |
$217.81
|
Rate for Payer: Cash Price |
$1,408.70
|
Rate for Payer: Cash Price |
$1,408.70
|
Rate for Payer: Cofinity Commercial |
$1,655.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.70
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
Rate for Payer: Healthscope Commercial |
$1,760.88
|
Rate for Payer: Healthscope Whirlpool |
$1,708.05
|
Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
Rate for Payer: Mclaren Commercial |
$1,584.79
|
Rate for Payer: Mclaren Medicaid |
$119.14
|
Rate for Payer: Mclaren Medicare |
$217.81
|
Rate for Payer: Meridian Medicaid |
$125.11
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,496.75
|
Rate for Payer: PACE Medicare |
$206.92
|
Rate for Payer: PACE SWMI |
$217.81
|
Rate for Payer: PHP Commercial |
$239.59
|
Rate for Payer: PHP Medicaid |
$119.14
|
Rate for Payer: PHP Medicare Advantage |
$217.81
|
Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,232.62
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.78
|
Rate for Payer: Priority Health Medicare |
$217.81
|
Rate for Payer: Priority Health Narrow Network |
$792.62
|
Rate for Payer: Railroad Medicare Medicare |
$217.81
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,549.57
|
Rate for Payer: UHC Medicare Advantage |
$224.34
|
Rate for Payer: VA VA |
$217.81
|
|
HC VENOUS INSUFFICIENCY BIL
|
Facility
|
IP
|
$1,760.88
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92000033
|
Hospital Revenue Code
|
920
|
Min. Negotiated Rate |
$1,232.62 |
Max. Negotiated Rate |
$1,760.88 |
Rate for Payer: Aetna Commercial |
$1,584.79
|
Rate for Payer: ASR ASR |
$1,708.05
|
Rate for Payer: BCBS Trust/PPO |
$1,365.21
|
Rate for Payer: BCN Commercial |
$1,365.21
|
Rate for Payer: Cash Price |
$1,408.70
|
Rate for Payer: Cofinity Commercial |
$1,655.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.70
|
Rate for Payer: Healthscope Commercial |
$1,760.88
|
Rate for Payer: Healthscope Whirlpool |
$1,708.05
|
Rate for Payer: Mclaren Commercial |
$1,584.79
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,496.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,232.62
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,549.57
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
IP
|
$4,553.46
|
|
Service Code
|
CPT 37212
|
Hospital Charge Code |
36100372
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$3,187.42 |
Max. Negotiated Rate |
$4,553.46 |
Rate for Payer: Aetna Commercial |
$4,098.11
|
Rate for Payer: ASR ASR |
$4,416.86
|
Rate for Payer: BCBS Trust/PPO |
$3,530.30
|
Rate for Payer: BCN Commercial |
$3,530.30
|
Rate for Payer: Cash Price |
$3,642.77
|
Rate for Payer: Cofinity Commercial |
$4,280.25
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
Rate for Payer: Healthscope Commercial |
$4,553.46
|
Rate for Payer: Healthscope Whirlpool |
$4,416.86
|
Rate for Payer: Mclaren Commercial |
$4,098.11
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,007.04
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
OP
|
$4,553.46
|
|
Service Code
|
CPT 37212
|
Hospital Charge Code |
36100372
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$672.89 |
Max. Negotiated Rate |
$4,553.46 |
Rate for Payer: Aetna Commercial |
$4,098.11
|
Rate for Payer: Aetna Medicare |
$2,833.29
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
Rate for Payer: ASR ASR |
$4,416.86
|
Rate for Payer: BCBS Complete |
$1,627.44
|
Rate for Payer: BCBS MAPPO |
$2,833.29
|
Rate for Payer: BCBS Trust/PPO |
$3,530.30
|
Rate for Payer: BCN Commercial |
$3,530.30
|
Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
Rate for Payer: Cash Price |
$3,642.77
|
Rate for Payer: Cash Price |
$3,642.77
|
Rate for Payer: Cofinity Commercial |
$4,280.25
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
Rate for Payer: Healthscope Commercial |
$4,553.46
|
Rate for Payer: Healthscope Whirlpool |
$4,416.86
|
Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
Rate for Payer: Mclaren Commercial |
$4,098.11
|
Rate for Payer: Mclaren Medicaid |
$1,549.81
|
Rate for Payer: Mclaren Medicare |
$2,833.29
|
Rate for Payer: Meridian Medicaid |
$1,627.44
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
Rate for Payer: PACE Medicare |
$2,691.63
|
Rate for Payer: PACE SWMI |
$2,833.29
|
Rate for Payer: PHP Commercial |
$3,116.62
|
Rate for Payer: PHP Medicaid |
$1,549.81
|
Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$841.11
|
Rate for Payer: Priority Health Medicare |
$2,833.29
|
Rate for Payer: Priority Health Narrow Network |
$672.89
|
Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,007.04
|
Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
Rate for Payer: VA VA |
$2,833.29
|
|
HC VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
OP
|
$1,381.07
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92100010
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$119.14 |
Max. Negotiated Rate |
$1,381.07 |
Rate for Payer: Aetna Commercial |
$1,242.96
|
Rate for Payer: Aetna Medicare |
$217.81
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
Rate for Payer: ASR ASR |
$1,339.64
|
Rate for Payer: BCBS Complete |
$125.11
|
Rate for Payer: BCBS MAPPO |
$217.81
|
Rate for Payer: BCBS Trust/PPO |
$1,070.74
|
Rate for Payer: BCN Commercial |
$1,070.74
|
Rate for Payer: BCN Medicare Advantage |
$217.81
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cofinity Commercial |
$1,298.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
Rate for Payer: Healthscope Commercial |
$1,381.07
|
Rate for Payer: Healthscope Whirlpool |
$1,339.64
|
Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
Rate for Payer: Mclaren Commercial |
$1,242.96
|
Rate for Payer: Mclaren Medicaid |
$119.14
|
Rate for Payer: Mclaren Medicare |
$217.81
|
Rate for Payer: Meridian Medicaid |
$125.11
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
Rate for Payer: PACE Medicare |
$206.92
|
Rate for Payer: PACE SWMI |
$217.81
|
Rate for Payer: PHP Commercial |
$239.59
|
Rate for Payer: PHP Medicaid |
$119.14
|
Rate for Payer: PHP Medicare Advantage |
$217.81
|
Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.78
|
Rate for Payer: Priority Health Medicare |
$217.81
|
Rate for Payer: Priority Health Narrow Network |
$792.62
|
Rate for Payer: Railroad Medicare Medicare |
$217.81
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,215.34
|
Rate for Payer: UHC Medicare Advantage |
$224.34
|
Rate for Payer: VA VA |
$217.81
|
|
HC VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
IP
|
$1,381.07
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92100010
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$966.75 |
Max. Negotiated Rate |
$1,381.07 |
Rate for Payer: Aetna Commercial |
$1,242.96
|
Rate for Payer: ASR ASR |
$1,339.64
|
Rate for Payer: BCBS Trust/PPO |
$1,070.74
|
Rate for Payer: BCN Commercial |
$1,070.74
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cofinity Commercial |
$1,298.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
Rate for Payer: Healthscope Commercial |
$1,381.07
|
Rate for Payer: Healthscope Whirlpool |
$1,339.64
|
Rate for Payer: Mclaren Commercial |
$1,242.96
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,215.34
|
|
HC VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
OP
|
$1,381.07
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92100028
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$119.14 |
Max. Negotiated Rate |
$1,381.07 |
Rate for Payer: Aetna Commercial |
$1,242.96
|
Rate for Payer: Aetna Medicare |
$217.81
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
Rate for Payer: ASR ASR |
$1,339.64
|
Rate for Payer: BCBS Complete |
$125.11
|
Rate for Payer: BCBS MAPPO |
$217.81
|
Rate for Payer: BCBS Trust/PPO |
$1,070.74
|
Rate for Payer: BCN Commercial |
$1,070.74
|
Rate for Payer: BCN Medicare Advantage |
$217.81
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cofinity Commercial |
$1,298.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
Rate for Payer: Healthscope Commercial |
$1,381.07
|
Rate for Payer: Healthscope Whirlpool |
$1,339.64
|
Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
Rate for Payer: Mclaren Commercial |
$1,242.96
|
Rate for Payer: Mclaren Medicaid |
$119.14
|
Rate for Payer: Mclaren Medicare |
$217.81
|
Rate for Payer: Meridian Medicaid |
$125.11
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
Rate for Payer: PACE Medicare |
$206.92
|
Rate for Payer: PACE SWMI |
$217.81
|
Rate for Payer: PHP Commercial |
$239.59
|
Rate for Payer: PHP Medicaid |
$119.14
|
Rate for Payer: PHP Medicare Advantage |
$217.81
|
Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.78
|
Rate for Payer: Priority Health Medicare |
$217.81
|
Rate for Payer: Priority Health Narrow Network |
$792.62
|
Rate for Payer: Railroad Medicare Medicare |
$217.81
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,215.34
|
Rate for Payer: UHC Medicare Advantage |
$224.34
|
Rate for Payer: VA VA |
$217.81
|
|
HC VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
IP
|
$1,381.07
|
|
Service Code
|
CPT 93970
|
Hospital Charge Code |
92100028
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$966.75 |
Max. Negotiated Rate |
$1,381.07 |
Rate for Payer: Aetna Commercial |
$1,242.96
|
Rate for Payer: ASR ASR |
$1,339.64
|
Rate for Payer: BCBS Trust/PPO |
$1,070.74
|
Rate for Payer: BCN Commercial |
$1,070.74
|
Rate for Payer: Cash Price |
$1,104.86
|
Rate for Payer: Cofinity Commercial |
$1,298.21
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
Rate for Payer: Healthscope Commercial |
$1,381.07
|
Rate for Payer: Healthscope Whirlpool |
$1,339.64
|
Rate for Payer: Mclaren Commercial |
$1,242.96
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,215.34
|
|
HC VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
OP
|
$850.62
|
|
Service Code
|
CPT 93971
|
Hospital Charge Code |
92100022
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$53.45 |
Max. Negotiated Rate |
$850.62 |
Rate for Payer: Aetna Commercial |
$765.56
|
Rate for Payer: Aetna Medicare |
$97.72
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
Rate for Payer: ASR ASR |
$825.10
|
Rate for Payer: BCBS Complete |
$56.13
|
Rate for Payer: BCBS MAPPO |
$97.72
|
Rate for Payer: BCBS Trust/PPO |
$659.49
|
Rate for Payer: BCN Commercial |
$659.49
|
Rate for Payer: BCN Medicare Advantage |
$97.72
|
Rate for Payer: Cash Price |
$680.50
|
Rate for Payer: Cash Price |
$680.50
|
Rate for Payer: Cofinity Commercial |
$799.58
|
Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
Rate for Payer: Healthscope Commercial |
$850.62
|
Rate for Payer: Healthscope Whirlpool |
$825.10
|
Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
Rate for Payer: Mclaren Commercial |
$765.56
|
Rate for Payer: Mclaren Medicaid |
$53.45
|
Rate for Payer: Mclaren Medicare |
$97.72
|
Rate for Payer: Meridian Medicaid |
$56.13
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
Rate for Payer: PACE Medicare |
$92.83
|
Rate for Payer: PACE SWMI |
$97.72
|
Rate for Payer: PHP Commercial |
$107.49
|
Rate for Payer: PHP Medicaid |
$53.45
|
Rate for Payer: PHP Medicare Advantage |
$97.72
|
Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.77
|
Rate for Payer: Priority Health Medicare |
$97.72
|
Rate for Payer: Priority Health Narrow Network |
$510.22
|
Rate for Payer: Railroad Medicare Medicare |
$97.72
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.55
|
Rate for Payer: UHC Medicare Advantage |
$100.65
|
Rate for Payer: VA VA |
$97.72
|
|
HC VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
IP
|
$850.62
|
|
Service Code
|
CPT 93971
|
Hospital Charge Code |
92100022
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$595.43 |
Max. Negotiated Rate |
$850.62 |
Rate for Payer: Aetna Commercial |
$765.56
|
Rate for Payer: ASR ASR |
$825.10
|
Rate for Payer: BCBS Trust/PPO |
$659.49
|
Rate for Payer: BCN Commercial |
$659.49
|
Rate for Payer: Cash Price |
$680.50
|
Rate for Payer: Cofinity Commercial |
$799.58
|
Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
Rate for Payer: Healthscope Commercial |
$850.62
|
Rate for Payer: Healthscope Whirlpool |
$825.10
|
Rate for Payer: Mclaren Commercial |
$765.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.55
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