|
HC ASP INTERVERTEBRAL DISC
|
Facility
|
OP
|
$826.95
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
36100297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.99 |
| Max. Negotiated Rate |
$1,945.97 |
| Rate for Payer: Aetna Commercial |
$702.91
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$342.74
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$661.56
|
| Rate for Payer: Cash Price |
$661.56
|
| Rate for Payer: Cofinity Commercial |
$711.18
|
| Rate for Payer: Cofinity Commercial |
$578.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$744.26
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.91
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$702.91
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.97
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,556.78
|
| Rate for Payer: Priority Health SBD |
$520.98
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.89
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$148.99
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC ASP INTERVERTEBRAL DISC
|
Facility
|
IP
|
$826.95
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
36100297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.98 |
| Max. Negotiated Rate |
$744.26 |
| Rate for Payer: Aetna Commercial |
$702.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.52
|
| Rate for Payer: Cash Price |
$661.56
|
| Rate for Payer: Cofinity Commercial |
$578.86
|
| Rate for Payer: Cofinity Commercial |
$711.18
|
| Rate for Payer: Healthscope Commercial |
$744.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.91
|
| Rate for Payer: PHP Commercial |
$702.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.86
|
| Rate for Payer: Priority Health SBD |
$520.98
|
|
|
HC ASPIRATE/INJ GANGLION CYST
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.54 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health SBD |
$238.54
|
|
|
HC ASPIRATE/INJ GANGLION CYST
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$24.62
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$40.28
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC ASPIRATION BLADDER WITH CATHETHER
|
Facility
|
OP
|
$3,066.89
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
36100250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Commercial |
$2,606.86
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,993.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$802.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,453.51
|
| Rate for Payer: Cash Price |
$2,453.51
|
| Rate for Payer: Cofinity Commercial |
$2,637.53
|
| Rate for Payer: Cofinity Commercial |
$2,146.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,760.20
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,606.86
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,606.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,146.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Priority Health SBD |
$1,932.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.00
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$138.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC ASPIRATION BLADDER WITH CATHETHER
|
Facility
|
IP
|
$3,066.89
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
36100250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,932.14 |
| Max. Negotiated Rate |
$2,760.20 |
| Rate for Payer: Aetna Commercial |
$2,606.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,993.48
|
| Rate for Payer: Cash Price |
$2,453.51
|
| Rate for Payer: Cofinity Commercial |
$2,146.82
|
| Rate for Payer: Cofinity Commercial |
$2,637.53
|
| Rate for Payer: Healthscope Commercial |
$2,760.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,606.86
|
| Rate for Payer: PHP Commercial |
$2,606.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,146.82
|
| Rate for Payer: Priority Health SBD |
$1,932.14
|
|
|
HC ASPIRATION CYST OVARIAN ABDOMINAL APPROACH UNI OR BIL
|
Facility
|
IP
|
$4,249.39
|
|
|
Service Code
|
CPT 58805
|
| Hospital Charge Code |
36100258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,677.12 |
| Max. Negotiated Rate |
$3,824.45 |
| Rate for Payer: Aetna Commercial |
$3,611.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,762.10
|
| Rate for Payer: Cash Price |
$3,399.51
|
| Rate for Payer: Cofinity Commercial |
$2,974.57
|
| Rate for Payer: Cofinity Commercial |
$3,654.48
|
| Rate for Payer: Healthscope Commercial |
$3,824.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,611.98
|
| Rate for Payer: PHP Commercial |
$3,611.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,974.57
|
| Rate for Payer: Priority Health SBD |
$2,677.12
|
|
|
HC ASPIRATION CYST OVARIAN ABDOMINAL APPROACH UNI OR BIL
|
Facility
|
OP
|
$4,249.39
|
|
|
Service Code
|
CPT 58805
|
| Hospital Charge Code |
36100258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.02 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Commercial |
$3,611.98
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,762.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$3,399.51
|
| Rate for Payer: Cash Price |
$3,399.51
|
| Rate for Payer: Cofinity Commercial |
$3,654.48
|
| Rate for Payer: Cofinity Commercial |
$2,974.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$3,824.45
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,611.98
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$3,611.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,974.57
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$2,677.12
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$425.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC ASPIRATION CYST OVARIAN VAGINAL APPROACH UNI OR BIL
|
Facility
|
OP
|
$2,494.41
|
|
|
Service Code
|
CPT 58800
|
| Hospital Charge Code |
36100257
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Commercial |
$2,120.25
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$1,995.53
|
| Rate for Payer: Cash Price |
$1,995.53
|
| Rate for Payer: Cofinity Commercial |
$1,746.09
|
| Rate for Payer: Cofinity Commercial |
$2,145.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$2,244.97
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,120.25
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$2,120.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.09
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$1,571.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.70
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$313.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC ASPIRATION CYST OVARIAN VAGINAL APPROACH UNI OR BIL
|
Facility
|
IP
|
$2,494.41
|
|
|
Service Code
|
CPT 58800
|
| Hospital Charge Code |
36100257
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,571.48 |
| Max. Negotiated Rate |
$2,244.97 |
| Rate for Payer: Aetna Commercial |
$2,120.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.37
|
| Rate for Payer: Cash Price |
$1,995.53
|
| Rate for Payer: Cofinity Commercial |
$1,746.09
|
| Rate for Payer: Cofinity Commercial |
$2,145.19
|
| Rate for Payer: Healthscope Commercial |
$2,244.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,120.25
|
| Rate for Payer: PHP Commercial |
$2,120.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.09
|
| Rate for Payer: Priority Health SBD |
$1,571.48
|
|
|
HC ASPIRATION DISK
|
Facility
|
IP
|
$4,523.74
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
32000003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,849.96 |
| Max. Negotiated Rate |
$4,071.37 |
| Rate for Payer: Aetna Commercial |
$3,845.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,940.43
|
| Rate for Payer: Cash Price |
$3,618.99
|
| Rate for Payer: Cofinity Commercial |
$3,890.42
|
| Rate for Payer: Cofinity Commercial |
$3,166.62
|
| Rate for Payer: Healthscope Commercial |
$4,071.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,845.18
|
| Rate for Payer: PHP Commercial |
$3,845.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,166.62
|
| Rate for Payer: Priority Health SBD |
$2,849.96
|
|
|
HC ASPIRATION DISK
|
Facility
|
OP
|
$4,523.74
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
32000003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$592.34 |
| Max. Negotiated Rate |
$5,389.95 |
| Rate for Payer: Aetna Commercial |
$3,845.18
|
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,940.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,637.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Cash Price |
$3,618.99
|
| Rate for Payer: Cash Price |
$3,618.99
|
| Rate for Payer: Cofinity Commercial |
$3,166.62
|
| Rate for Payer: Cofinity Commercial |
$3,890.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Healthscope Commercial |
$4,071.37
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,845.18
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Commercial |
$3,845.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,166.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,389.95
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,311.96
|
| Rate for Payer: Priority Health SBD |
$2,849.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$592.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
HC ASPIRATION SIMPLE
|
Facility
|
IP
|
$406.40
|
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.03 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.16
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$284.48
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health SBD |
$256.03
|
|
|
HC ASPIRATION SIMPLE
|
Facility
|
OP
|
$406.40
|
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.16
|
| Rate for Payer: BCBS Complete |
$162.56
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$284.48
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health SBD |
$256.03
|
|
|
HC ASPIRATION THYROID CYST
|
Facility
|
IP
|
$484.17
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
36100266
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.03 |
| Max. Negotiated Rate |
$435.75 |
| Rate for Payer: Aetna Commercial |
$411.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.71
|
| Rate for Payer: Cash Price |
$387.34
|
| Rate for Payer: Cofinity Commercial |
$338.92
|
| Rate for Payer: Cofinity Commercial |
$416.39
|
| Rate for Payer: Healthscope Commercial |
$435.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.54
|
| Rate for Payer: PHP Commercial |
$411.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.92
|
| Rate for Payer: Priority Health SBD |
$305.03
|
|
|
HC ASPIRATION THYROID CYST
|
Facility
|
OP
|
$484.17
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
36100266
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$1,945.97 |
| Rate for Payer: Aetna Commercial |
$411.54
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$60.35
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$387.34
|
| Rate for Payer: Cash Price |
$387.34
|
| Rate for Payer: Cofinity Commercial |
$338.92
|
| Rate for Payer: Cofinity Commercial |
$416.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$435.75
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.54
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$411.54
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.97
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,556.78
|
| Rate for Payer: Priority Health SBD |
$305.03
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.50
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC ASSMT & CARE PLN PT COG IMP
|
Facility
|
IP
|
$229.10
|
|
|
Service Code
|
CPT 99483
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$206.19 |
| Rate for Payer: Aetna Commercial |
$194.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.92
|
| Rate for Payer: Cash Price |
$183.28
|
| Rate for Payer: Cofinity Commercial |
$160.37
|
| Rate for Payer: Cofinity Commercial |
$197.03
|
| Rate for Payer: Healthscope Commercial |
$206.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.74
|
| Rate for Payer: PHP Commercial |
$194.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.37
|
| Rate for Payer: Priority Health SBD |
$144.33
|
|
|
HC ASSMT & CARE PLN PT COG IMP
|
Facility
|
OP
|
$229.10
|
|
|
Service Code
|
CPT 99483
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$444.51 |
| Rate for Payer: Aetna Commercial |
$194.74
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCBS Trust/PPO |
$444.51
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$183.28
|
| Rate for Payer: Cash Price |
$183.28
|
| Rate for Payer: Cofinity Commercial |
$197.03
|
| Rate for Payer: Cofinity Commercial |
$160.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$206.19
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.74
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$194.74
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.97
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$186.38
|
| Rate for Payer: Priority Health SBD |
$144.33
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$187.95
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC ASTIGMATISM CORRECT FXN IOL
|
Facility
|
OP
|
$1,573.87
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27600002
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$629.55 |
| Max. Negotiated Rate |
$1,416.48 |
| Rate for Payer: Aetna Commercial |
$1,337.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,023.02
|
| Rate for Payer: BCBS Complete |
$629.55
|
| Rate for Payer: Cash Price |
$1,259.10
|
| Rate for Payer: Cofinity Commercial |
$1,101.71
|
| Rate for Payer: Cofinity Commercial |
$1,353.53
|
| Rate for Payer: Healthscope Commercial |
$1,416.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,337.79
|
| Rate for Payer: PHP Commercial |
$1,337.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.71
|
| Rate for Payer: Priority Health SBD |
$991.54
|
|
|
HC ASTIGMATISM CORRECT FXN IOL
|
Facility
|
IP
|
$1,573.87
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27600002
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$991.54 |
| Max. Negotiated Rate |
$1,416.48 |
| Rate for Payer: Aetna Commercial |
$1,337.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,023.02
|
| Rate for Payer: Cash Price |
$1,259.10
|
| Rate for Payer: Cofinity Commercial |
$1,101.71
|
| Rate for Payer: Cofinity Commercial |
$1,353.53
|
| Rate for Payer: Healthscope Commercial |
$1,416.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,337.79
|
| Rate for Payer: PHP Commercial |
$1,337.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.71
|
| Rate for Payer: Priority Health SBD |
$991.54
|
|
|
HC ATHERECT ABDOMINAL AORTA
|
Facility
|
IP
|
$14,597.63
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
36100300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,196.51 |
| Max. Negotiated Rate |
$13,137.87 |
| Rate for Payer: Aetna Commercial |
$12,407.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,488.46
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cofinity Commercial |
$10,218.34
|
| Rate for Payer: Cofinity Commercial |
$12,553.96
|
| Rate for Payer: Healthscope Commercial |
$13,137.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,407.99
|
| Rate for Payer: PHP Commercial |
$12,407.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,218.34
|
| Rate for Payer: Priority Health SBD |
$9,196.51
|
|
|
HC ATHERECT ABDOMINAL AORTA
|
Facility
|
OP
|
$14,597.63
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
36100300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,076.51 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$12,407.99
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,488.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cofinity Commercial |
$10,218.34
|
| Rate for Payer: Cofinity Commercial |
$12,553.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$13,137.87
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,407.99
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$12,407.99
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,218.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$9,196.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC ATHERECT BRACHIOCEPHAL EA V
|
Facility
|
OP
|
$14,597.63
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
36100301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,076.51 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$12,407.99
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,488.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cofinity Commercial |
$12,553.96
|
| Rate for Payer: Cofinity Commercial |
$10,218.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$13,137.87
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,407.99
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$12,407.99
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,218.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$9,196.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC ATHERECT BRACHIOCEPHAL EA V
|
Facility
|
IP
|
$14,597.63
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
36100301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,196.51 |
| Max. Negotiated Rate |
$13,137.87 |
| Rate for Payer: Aetna Commercial |
$12,407.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,488.46
|
| Rate for Payer: Cash Price |
$11,678.10
|
| Rate for Payer: Cofinity Commercial |
$10,218.34
|
| Rate for Payer: Cofinity Commercial |
$12,553.96
|
| Rate for Payer: Healthscope Commercial |
$13,137.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,407.99
|
| Rate for Payer: PHP Commercial |
$12,407.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,218.34
|
| Rate for Payer: Priority Health SBD |
$9,196.51
|
|
|
HC ATHERECT ILIAC ARTERY EA VE
|
Facility
|
OP
|
$11,848.47
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
36100302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,464.54 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$10,071.20
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,701.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,808.80
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$9,478.78
|
| Rate for Payer: Cash Price |
$9,478.78
|
| Rate for Payer: Cofinity Commercial |
$8,293.93
|
| Rate for Payer: Cofinity Commercial |
$10,189.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$10,663.62
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,071.20
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$10,071.20
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,293.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$7,464.54
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
