|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,390.22
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$2,390.22 |
| Rate for Payer: Aetna Commercial |
$2,151.20
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$2,318.51
|
| Rate for Payer: ASR Commercial |
$2,318.51
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,957.35
|
| Rate for Payer: BCCCP Commercial |
$240.24
|
| Rate for Payer: BCN Commercial |
$1,853.14
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cofinity Commercial |
$2,246.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$2,390.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,318.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$2,151.20
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.69
|
| Rate for Payer: Nomi Health Commercial |
$1,959.98
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,553.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.49
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$89.99
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,103.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$1,962.98 |
| Rate for Payer: Aetna Commercial |
$1,766.68
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$1,904.09
|
| Rate for Payer: ASR Commercial |
$1,904.09
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,607.48
|
| Rate for Payer: BCCCP Commercial |
$330.02
|
| Rate for Payer: BCN Commercial |
$1,521.90
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,845.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$1,962.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$1,766.68
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.53
|
| Rate for Payer: Nomi Health Commercial |
$1,609.64
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.49
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$89.99
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.94 |
| Max. Negotiated Rate |
$1,962.98 |
| Rate for Payer: Aetna Commercial |
$1,766.68
|
| Rate for Payer: ASR ASR |
$1,904.09
|
| Rate for Payer: ASR Commercial |
$1,904.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.63
|
| Rate for Payer: BCN Commercial |
$1,521.90
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,845.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Healthscope Commercial |
$1,962.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.09
|
| Rate for Payer: Mclaren Commercial |
$1,766.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.53
|
| Rate for Payer: Nomi Health Commercial |
$1,609.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.42
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna Medicare |
$535.50
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: ASR Commercial |
$1,038.87
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$877.04
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.41
|
| Rate for Payer: Priority Health Narrow Network |
$750.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$696.15 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: ASR Commercial |
$1,038.87
|
| Rate for Payer: BCBS Trust/PPO |
$872.76
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,906.35 |
| Max. Negotiated Rate |
$7,265.88 |
| Rate for Payer: Aetna Commercial |
$6,539.29
|
| Rate for Payer: Aetna Medicare |
$3,632.94
|
| Rate for Payer: ASR ASR |
$7,047.90
|
| Rate for Payer: ASR Commercial |
$7,047.90
|
| Rate for Payer: BCBS Complete |
$2,906.35
|
| Rate for Payer: BCBS Trust/PPO |
$5,950.03
|
| Rate for Payer: BCN Commercial |
$5,633.24
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$6,829.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Healthscope Commercial |
$7,265.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,047.90
|
| Rate for Payer: Mclaren Commercial |
$6,539.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: Nomi Health Commercial |
$5,958.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,366.36
|
| Rate for Payer: Priority Health Narrow Network |
$5,093.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,393.97
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,722.82 |
| Max. Negotiated Rate |
$7,265.88 |
| Rate for Payer: Aetna Commercial |
$6,539.29
|
| Rate for Payer: ASR ASR |
$7,047.90
|
| Rate for Payer: ASR Commercial |
$7,047.90
|
| Rate for Payer: BCBS Trust/PPO |
$5,920.97
|
| Rate for Payer: BCN Commercial |
$5,633.24
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$6,829.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Healthscope Commercial |
$7,265.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,047.90
|
| Rate for Payer: Mclaren Commercial |
$6,539.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: Nomi Health Commercial |
$5,958.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,393.97
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: ASR ASR |
$989.40
|
| Rate for Payer: ASR Commercial |
$989.40
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: BCBS Trust/PPO |
$835.28
|
| Rate for Payer: BCN Commercial |
$790.81
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$958.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$1,020.00
|
| Rate for Payer: Healthscope Whirlpool |
$989.40
|
| Rate for Payer: Mclaren Commercial |
$918.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: Nomi Health Commercial |
$836.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.72
|
| Rate for Payer: Priority Health Narrow Network |
$715.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.60
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: ASR ASR |
$989.40
|
| Rate for Payer: ASR Commercial |
$989.40
|
| Rate for Payer: BCBS Trust/PPO |
$831.20
|
| Rate for Payer: BCN Commercial |
$790.81
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$958.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$1,020.00
|
| Rate for Payer: Healthscope Whirlpool |
$989.40
|
| Rate for Payer: Mclaren Commercial |
$918.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: Nomi Health Commercial |
$836.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.60
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
OP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.22 |
| Max. Negotiated Rate |
$845.54 |
| Rate for Payer: Aetna Commercial |
$760.99
|
| Rate for Payer: Aetna Medicare |
$422.77
|
| Rate for Payer: ASR ASR |
$820.17
|
| Rate for Payer: ASR Commercial |
$820.17
|
| Rate for Payer: BCBS Complete |
$338.22
|
| Rate for Payer: BCBS Trust/PPO |
$692.41
|
| Rate for Payer: BCN Commercial |
$655.55
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$794.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Healthscope Commercial |
$845.54
|
| Rate for Payer: Healthscope Whirlpool |
$820.17
|
| Rate for Payer: Mclaren Commercial |
$760.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: Nomi Health Commercial |
$693.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.86
|
| Rate for Payer: Priority Health Narrow Network |
$592.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.08
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
IP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$845.54 |
| Rate for Payer: Aetna Commercial |
$760.99
|
| Rate for Payer: ASR ASR |
$820.17
|
| Rate for Payer: ASR Commercial |
$820.17
|
| Rate for Payer: BCBS Trust/PPO |
$689.03
|
| Rate for Payer: BCN Commercial |
$655.55
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$794.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Healthscope Commercial |
$845.54
|
| Rate for Payer: Healthscope Whirlpool |
$820.17
|
| Rate for Payer: Mclaren Commercial |
$760.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: Nomi Health Commercial |
$693.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.08
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: Aetna Medicare |
$561.43
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Complete |
$449.14
|
| Rate for Payer: BCBS Trust/PPO |
$919.51
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.85
|
| Rate for Payer: Priority Health Narrow Network |
$787.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$729.86 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
IP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,790.44 |
| Max. Negotiated Rate |
$10,446.83 |
| Rate for Payer: Aetna Commercial |
$9,402.15
|
| Rate for Payer: ASR ASR |
$10,133.43
|
| Rate for Payer: ASR Commercial |
$10,133.43
|
| Rate for Payer: BCBS Trust/PPO |
$8,513.12
|
| Rate for Payer: BCN Commercial |
$8,099.43
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$9,820.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Healthscope Commercial |
$10,446.83
|
| Rate for Payer: Healthscope Whirlpool |
$10,133.43
|
| Rate for Payer: Mclaren Commercial |
$9,402.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: Nomi Health Commercial |
$8,566.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,193.21
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
OP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,178.73 |
| Max. Negotiated Rate |
$10,446.83 |
| Rate for Payer: Aetna Commercial |
$9,402.15
|
| Rate for Payer: Aetna Medicare |
$5,223.42
|
| Rate for Payer: ASR ASR |
$10,133.43
|
| Rate for Payer: ASR Commercial |
$10,133.43
|
| Rate for Payer: BCBS Complete |
$4,178.73
|
| Rate for Payer: BCBS Trust/PPO |
$8,554.91
|
| Rate for Payer: BCN Commercial |
$8,099.43
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$9,820.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Healthscope Commercial |
$10,446.83
|
| Rate for Payer: Healthscope Whirlpool |
$10,133.43
|
| Rate for Payer: Mclaren Commercial |
$9,402.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: Nomi Health Commercial |
$8,566.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,153.51
|
| Rate for Payer: Priority Health Narrow Network |
$7,323.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,193.21
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Trust/PPO |
$831.83
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.31 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$510.39
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$408.31
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.41
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
IP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$930.40 |
| Rate for Payer: Aetna Commercial |
$837.36
|
| Rate for Payer: ASR ASR |
$902.49
|
| Rate for Payer: ASR Commercial |
$902.49
|
| Rate for Payer: BCBS Trust/PPO |
$758.18
|
| Rate for Payer: BCN Commercial |
$721.34
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$874.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Healthscope Commercial |
$930.40
|
| Rate for Payer: Healthscope Whirlpool |
$902.49
|
| Rate for Payer: Mclaren Commercial |
$837.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: Nomi Health Commercial |
$762.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.75
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
OP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.16 |
| Max. Negotiated Rate |
$930.40 |
| Rate for Payer: Aetna Commercial |
$837.36
|
| Rate for Payer: Aetna Medicare |
$465.20
|
| Rate for Payer: ASR ASR |
$902.49
|
| Rate for Payer: ASR Commercial |
$902.49
|
| Rate for Payer: BCBS Complete |
$372.16
|
| Rate for Payer: BCBS Trust/PPO |
$761.90
|
| Rate for Payer: BCN Commercial |
$721.34
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$874.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Healthscope Commercial |
$930.40
|
| Rate for Payer: Healthscope Whirlpool |
$902.49
|
| Rate for Payer: Mclaren Commercial |
$837.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: Nomi Health Commercial |
$762.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.22
|
| Rate for Payer: Priority Health Narrow Network |
$652.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.75
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
OP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,655.78 |
| Max. Negotiated Rate |
$6,639.46 |
| Rate for Payer: Aetna Commercial |
$5,975.51
|
| Rate for Payer: Aetna Medicare |
$3,319.73
|
| Rate for Payer: ASR ASR |
$6,440.28
|
| Rate for Payer: ASR Commercial |
$6,440.28
|
| Rate for Payer: BCBS Complete |
$2,655.78
|
| Rate for Payer: BCBS Trust/PPO |
$5,437.05
|
| Rate for Payer: BCN Commercial |
$5,147.57
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$6,241.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Healthscope Commercial |
$6,639.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,440.28
|
| Rate for Payer: Mclaren Commercial |
$5,975.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: Nomi Health Commercial |
$5,444.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,817.49
|
| Rate for Payer: Priority Health Narrow Network |
$4,654.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,842.72
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
IP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,315.65 |
| Max. Negotiated Rate |
$6,639.46 |
| Rate for Payer: Aetna Commercial |
$5,975.51
|
| Rate for Payer: ASR ASR |
$6,440.28
|
| Rate for Payer: ASR Commercial |
$6,440.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,410.50
|
| Rate for Payer: BCN Commercial |
$5,147.57
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$6,241.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Healthscope Commercial |
$6,639.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,440.28
|
| Rate for Payer: Mclaren Commercial |
$5,975.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: Nomi Health Commercial |
$5,444.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,842.72
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
IP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,586.60 |
| Max. Negotiated Rate |
$5,517.84 |
| Rate for Payer: Aetna Commercial |
$4,966.06
|
| Rate for Payer: ASR ASR |
$5,352.30
|
| Rate for Payer: ASR Commercial |
$5,352.30
|
| Rate for Payer: BCBS Trust/PPO |
$4,496.49
|
| Rate for Payer: BCN Commercial |
$4,277.98
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$5,186.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Healthscope Commercial |
$5,517.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,352.30
|
| Rate for Payer: Mclaren Commercial |
$4,966.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: Nomi Health Commercial |
$4,524.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,855.70
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
OP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,207.14 |
| Max. Negotiated Rate |
$5,517.84 |
| Rate for Payer: Aetna Commercial |
$4,966.06
|
| Rate for Payer: Aetna Medicare |
$2,758.92
|
| Rate for Payer: ASR ASR |
$5,352.30
|
| Rate for Payer: ASR Commercial |
$5,352.30
|
| Rate for Payer: BCBS Complete |
$2,207.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,518.56
|
| Rate for Payer: BCN Commercial |
$4,277.98
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$5,186.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Healthscope Commercial |
$5,517.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,352.30
|
| Rate for Payer: Mclaren Commercial |
$4,966.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: Nomi Health Commercial |
$4,524.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,834.73
|
| Rate for Payer: Priority Health Narrow Network |
$3,868.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,855.70
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$3,348.21 |
| Rate for Payer: Aetna Commercial |
$3,013.39
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$3,247.76
|
| Rate for Payer: ASR Commercial |
$3,247.76
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,741.85
|
| Rate for Payer: BCN Commercial |
$2,595.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$3,147.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$3,348.21
|
| Rate for Payer: Healthscope Whirlpool |
$3,247.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$3,013.39
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,933.70
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,347.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,946.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
IP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,176.34 |
| Max. Negotiated Rate |
$3,348.21 |
| Rate for Payer: Aetna Commercial |
$3,013.39
|
| Rate for Payer: ASR ASR |
$3,247.76
|
| Rate for Payer: ASR Commercial |
$3,247.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,728.46
|
| Rate for Payer: BCN Commercial |
$2,595.87
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$3,147.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Healthscope Commercial |
$3,348.21
|
| Rate for Payer: Healthscope Whirlpool |
$3,247.76
|
| Rate for Payer: Mclaren Commercial |
$3,013.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,946.42
|
|
