|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,365.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,928.50
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$4,234.05
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,598.94
|
| Rate for Payer: BCN Commercial |
$3,598.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cofinity Commercial |
$4,103.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,234.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,365.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,928.50
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,710.25
|
| Rate for Payer: Nomi Health Commercial |
$3,579.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,273.75
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,824.61
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,059.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,841.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,365.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,273.75 |
| Max. Negotiated Rate |
$4,365.00 |
| Rate for Payer: Aetna Commercial |
$3,928.50
|
| Rate for Payer: ASR ASR |
$4,234.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,584.54
|
| Rate for Payer: BCN Commercial |
$3,584.54
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cofinity Commercial |
$4,103.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,492.00
|
| Rate for Payer: Healthscope Commercial |
$4,234.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,365.00
|
| Rate for Payer: Mclaren Commercial |
$3,928.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,710.25
|
| Rate for Payer: Nomi Health Commercial |
$3,579.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,273.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,841.20
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$710.23
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.67 |
| Max. Negotiated Rate |
$710.23 |
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: ASR ASR |
$688.92
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$583.24
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cofinity Commercial |
$667.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.18
|
| Rate for Payer: Healthscope Commercial |
$688.92
|
| Rate for Payer: Healthscope Whirlpool |
$710.23
|
| Rate for Payer: Mclaren Commercial |
$639.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.70
|
| Rate for Payer: Nomi Health Commercial |
$582.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.00
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$710.23
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$710.23 |
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$688.92
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$585.58
|
| Rate for Payer: BCN Commercial |
$585.58
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cofinity Commercial |
$667.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$688.92
|
| Rate for Payer: Healthscope Whirlpool |
$710.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$639.21
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.70
|
| Rate for Payer: Nomi Health Commercial |
$582.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.67
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.63
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$58.10
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.77 |
| Max. Negotiated Rate |
$1,118.31 |
| Rate for Payer: Aetna Commercial |
$1,006.48
|
| Rate for Payer: Aetna Medicare |
$413.77
|
| Rate for Payer: ASR ASR |
$1,084.76
|
| Rate for Payer: BCBS Complete |
$447.32
|
| Rate for Payer: BCBS Trust/PPO |
$922.05
|
| Rate for Payer: BCN Commercial |
$922.05
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Commercial |
$1,051.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,084.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,118.31
|
| Rate for Payer: Mclaren Commercial |
$1,006.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Nomi Health Commercial |
$917.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$979.86
|
| Rate for Payer: Priority Health Narrow Network |
$783.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$984.11
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.73 |
| Max. Negotiated Rate |
$1,118.31 |
| Rate for Payer: Aetna Commercial |
$1,006.48
|
| Rate for Payer: ASR ASR |
$1,084.76
|
| Rate for Payer: BCBS Trust/PPO |
$918.36
|
| Rate for Payer: BCN Commercial |
$918.36
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Commercial |
$1,051.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,084.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,118.31
|
| Rate for Payer: Mclaren Commercial |
$1,006.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Nomi Health Commercial |
$917.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$984.11
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,363.61 |
| Max. Negotiated Rate |
$6,388.13 |
| Rate for Payer: Aetna Commercial |
$5,749.32
|
| Rate for Payer: Aetna Medicare |
$2,363.61
|
| Rate for Payer: ASR ASR |
$6,196.49
|
| Rate for Payer: BCBS Complete |
$2,555.25
|
| Rate for Payer: BCBS Trust/PPO |
$5,267.01
|
| Rate for Payer: BCN Commercial |
$5,267.01
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Commercial |
$6,004.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$6,196.49
|
| Rate for Payer: Healthscope Whirlpool |
$6,388.13
|
| Rate for Payer: Mclaren Commercial |
$5,749.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,110.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Nomi Health Commercial |
$5,238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,597.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,478.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,621.55
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,791.10 |
| Max. Negotiated Rate |
$6,388.13 |
| Rate for Payer: Aetna Commercial |
$5,749.32
|
| Rate for Payer: ASR ASR |
$6,196.49
|
| Rate for Payer: BCBS Trust/PPO |
$5,245.93
|
| Rate for Payer: BCN Commercial |
$5,245.93
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Commercial |
$6,004.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$6,196.49
|
| Rate for Payer: Healthscope Whirlpool |
$6,388.13
|
| Rate for Payer: Mclaren Commercial |
$5,749.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Nomi Health Commercial |
$5,238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,621.55
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.68 |
| Max. Negotiated Rate |
$2,493.73 |
| Rate for Payer: Aetna Commercial |
$2,244.36
|
| Rate for Payer: Aetna Medicare |
$922.68
|
| Rate for Payer: ASR ASR |
$2,418.92
|
| Rate for Payer: BCBS Complete |
$997.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,056.08
|
| Rate for Payer: BCN Commercial |
$2,056.08
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Commercial |
$2,344.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,418.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.73
|
| Rate for Payer: Mclaren Commercial |
$2,244.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Nomi Health Commercial |
$2,044.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,185.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,748.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.48
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,870.30 |
| Max. Negotiated Rate |
$2,493.73 |
| Rate for Payer: Aetna Commercial |
$2,244.36
|
| Rate for Payer: ASR ASR |
$2,418.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,047.85
|
| Rate for Payer: BCN Commercial |
$2,047.85
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Commercial |
$2,344.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,418.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.73
|
| Rate for Payer: Mclaren Commercial |
$2,244.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Nomi Health Commercial |
$2,044.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.48
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.37
|
| Rate for Payer: BCN Commercial |
$3,237.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,440.37
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,752.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,944.85 |
| Max. Negotiated Rate |
$3,926.47 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,224.42
|
| Rate for Payer: BCN Commercial |
$3,224.42
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,752.46 |
| Max. Negotiated Rate |
$8,593.94 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: Aetna Medicare |
$5,544.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.37
|
| Rate for Payer: BCN Commercial |
$3,237.37
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,544.48
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$3,045.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,098.93
|
| Rate for Payer: PHP Medicaid |
$2,971.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,440.37
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,752.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$8,593.94
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP DNSP |
$5,544.48
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,944.85 |
| Max. Negotiated Rate |
$3,926.47 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,224.42
|
| Rate for Payer: BCN Commercial |
$3,224.42
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$422.82 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: ASR ASR |
$410.14
|
| Rate for Payer: BCBS Trust/PPO |
$347.22
|
| Rate for Payer: BCN Commercial |
$347.22
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$397.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$410.14
|
| Rate for Payer: Healthscope Whirlpool |
$422.82
|
| Rate for Payer: Mclaren Commercial |
$380.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.08
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$422.82 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: Aetna Medicare |
$156.44
|
| Rate for Payer: ASR ASR |
$410.14
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: BCBS Trust/PPO |
$348.62
|
| Rate for Payer: BCN Commercial |
$348.62
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$397.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$410.14
|
| Rate for Payer: Healthscope Whirlpool |
$422.82
|
| Rate for Payer: Mclaren Commercial |
$380.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$370.47
|
| Rate for Payer: Priority Health Narrow Network |
$296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.08
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$1,044.59 |
| Rate for Payer: Aetna Commercial |
$940.13
|
| Rate for Payer: Aetna Medicare |
$386.50
|
| Rate for Payer: ASR ASR |
$1,013.25
|
| Rate for Payer: BCBS Complete |
$417.84
|
| Rate for Payer: BCBS Trust/PPO |
$861.26
|
| Rate for Payer: BCN Commercial |
$861.26
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Commercial |
$981.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$1,013.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.59
|
| Rate for Payer: Mclaren Commercial |
$940.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Nomi Health Commercial |
$856.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$915.27
|
| Rate for Payer: Priority Health Narrow Network |
$732.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.24
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$783.44 |
| Max. Negotiated Rate |
$1,044.59 |
| Rate for Payer: Aetna Commercial |
$940.13
|
| Rate for Payer: ASR ASR |
$1,013.25
|
| Rate for Payer: BCBS Trust/PPO |
$857.82
|
| Rate for Payer: BCN Commercial |
$857.82
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Commercial |
$981.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$1,013.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.59
|
| Rate for Payer: Mclaren Commercial |
$940.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Nomi Health Commercial |
$856.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.24
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$482.18 |
| Max. Negotiated Rate |
$1,303.18 |
| Rate for Payer: Aetna Commercial |
$1,172.86
|
| Rate for Payer: Aetna Medicare |
$482.18
|
| Rate for Payer: ASR ASR |
$1,264.08
|
| Rate for Payer: BCBS Complete |
$521.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,074.47
|
| Rate for Payer: BCN Commercial |
$1,074.47
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Commercial |
$1,224.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,264.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.18
|
| Rate for Payer: Mclaren Commercial |
$1,172.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,042.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Nomi Health Commercial |
$1,068.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,141.85
|
| Rate for Payer: Priority Health Narrow Network |
$913.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.80
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$977.38 |
| Max. Negotiated Rate |
$1,303.18 |
| Rate for Payer: Aetna Commercial |
$1,172.86
|
| Rate for Payer: ASR ASR |
$1,264.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.17
|
| Rate for Payer: BCN Commercial |
$1,070.17
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Commercial |
$1,224.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,264.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.18
|
| Rate for Payer: Mclaren Commercial |
$1,172.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Nomi Health Commercial |
$1,068.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.80
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,550.10 |
| Max. Negotiated Rate |
$6,892.15 |
| Rate for Payer: Aetna Commercial |
$6,202.94
|
| Rate for Payer: Aetna Medicare |
$2,550.10
|
| Rate for Payer: ASR ASR |
$6,685.39
|
| Rate for Payer: BCBS Complete |
$2,756.86
|
| Rate for Payer: BCBS Trust/PPO |
$5,682.58
|
| Rate for Payer: BCN Commercial |
$5,682.58
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Commercial |
$6,478.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,685.39
|
| Rate for Payer: Healthscope Whirlpool |
$6,892.15
|
| Rate for Payer: Mclaren Commercial |
$6,202.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,513.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Nomi Health Commercial |
$5,651.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,038.90
|
| Rate for Payer: Priority Health Narrow Network |
$4,831.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,065.09
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,169.11 |
| Max. Negotiated Rate |
$6,892.15 |
| Rate for Payer: Aetna Commercial |
$6,202.94
|
| Rate for Payer: ASR ASR |
$6,685.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,659.83
|
| Rate for Payer: BCN Commercial |
$5,659.83
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Commercial |
$6,478.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,685.39
|
| Rate for Payer: Healthscope Whirlpool |
$6,892.15
|
| Rate for Payer: Mclaren Commercial |
$6,202.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Nomi Health Commercial |
$5,651.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,065.09
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,292.24 |
| Max. Negotiated Rate |
$57,546.60 |
| Rate for Payer: Aetna Commercial |
$51,791.94
|
| Rate for Payer: Aetna Medicare |
$21,292.24
|
| Rate for Payer: ASR ASR |
$55,820.20
|
| Rate for Payer: BCBS Complete |
$23,018.64
|
| Rate for Payer: BCBS Trust/PPO |
$47,447.17
|
| Rate for Payer: BCN Commercial |
$47,447.17
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Commercial |
$54,093.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$55,820.20
|
| Rate for Payer: Healthscope Whirlpool |
$57,546.60
|
| Rate for Payer: Mclaren Commercial |
$51,791.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,037.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Nomi Health Commercial |
$47,188.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50,422.33
|
| Rate for Payer: Priority Health Narrow Network |
$40,340.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50,641.01
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43,159.95 |
| Max. Negotiated Rate |
$57,546.60 |
| Rate for Payer: Aetna Commercial |
$51,791.94
|
| Rate for Payer: ASR ASR |
$55,820.20
|
| Rate for Payer: BCBS Trust/PPO |
$47,257.27
|
| Rate for Payer: BCN Commercial |
$47,257.27
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Commercial |
$54,093.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$55,820.20
|
| Rate for Payer: Healthscope Whirlpool |
$57,546.60
|
| Rate for Payer: Mclaren Commercial |
$51,791.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Nomi Health Commercial |
$47,188.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50,641.01
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,955.75
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,533.63 |
| Max. Negotiated Rate |
$14,955.75 |
| Rate for Payer: Aetna Commercial |
$13,460.17
|
| Rate for Payer: Aetna Medicare |
$5,533.63
|
| Rate for Payer: ASR ASR |
$14,507.08
|
| Rate for Payer: BCBS Complete |
$5,982.30
|
| Rate for Payer: BCBS Trust/PPO |
$12,331.02
|
| Rate for Payer: BCN Commercial |
$12,331.02
|
| Rate for Payer: Cash Price |
$11,964.60
|
| Rate for Payer: Cofinity Commercial |
$14,058.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,964.60
|
| Rate for Payer: Healthscope Commercial |
$14,507.08
|
| Rate for Payer: Healthscope Whirlpool |
$14,955.75
|
| Rate for Payer: Mclaren Commercial |
$13,460.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,964.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,712.39
|
| Rate for Payer: Nomi Health Commercial |
$12,263.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,216.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,104.23
|
| Rate for Payer: Priority Health Narrow Network |
$10,483.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,161.06
|
|
