|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Aetna Commercial |
$615.40
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$85.34
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$506.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$651.60
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$615.40
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$615.40
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.80
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$456.12
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$106.25
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Aetna Commercial |
$90.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.06
|
| Rate for Payer: BCBS Complete |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$55.61
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Cofinity Commercial |
$91.38
|
| Rate for Payer: Healthscope Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.31
|
| Rate for Payer: PHP Commercial |
$90.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.38
|
| Rate for Payer: Priority Health SBD |
$66.94
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$106.25
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$66.94 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Aetna Commercial |
$90.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.06
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cofinity Commercial |
$91.38
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Healthscope Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.31
|
| Rate for Payer: PHP Commercial |
$90.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.38
|
| Rate for Payer: Priority Health SBD |
$66.94
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$380.80
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.11
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$385.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$403.20
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.80
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$380.80
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.60
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$282.24
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$25.54
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.24 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$380.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.20
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$385.28
|
| Rate for Payer: Healthscope Commercial |
$403.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.80
|
| Rate for Payer: PHP Commercial |
$380.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.60
|
| Rate for Payer: Priority Health SBD |
$282.24
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$14,199.46
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,945.66 |
| Max. Negotiated Rate |
$12,779.51 |
| Rate for Payer: Aetna Commercial |
$12,069.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,229.65
|
| Rate for Payer: Cash Price |
$11,359.57
|
| Rate for Payer: Cofinity Commercial |
$12,211.54
|
| Rate for Payer: Cofinity Commercial |
$9,939.62
|
| Rate for Payer: Healthscope Commercial |
$12,779.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,069.54
|
| Rate for Payer: PHP Commercial |
$12,069.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,939.62
|
| Rate for Payer: Priority Health SBD |
$8,945.66
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$14,199.46
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$12,779.51 |
| Rate for Payer: Aetna Commercial |
$12,069.54
|
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,229.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,505.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Cash Price |
$11,359.57
|
| Rate for Payer: Cash Price |
$11,359.57
|
| Rate for Payer: Cofinity Commercial |
$9,939.62
|
| Rate for Payer: Cofinity Commercial |
$12,211.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Healthscope Commercial |
$12,779.51
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,069.54
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Commercial |
$12,069.54
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,939.62
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Priority Health SBD |
$8,945.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$85.34
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$765.40
|
| Rate for Payer: Cofinity Commercial |
$623.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.50
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$756.50
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$560.70
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.70 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.50
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$623.00
|
| Rate for Payer: Cofinity Commercial |
$765.40
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.50
|
| Rate for Payer: PHP Commercial |
$756.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health SBD |
$560.70
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
OP
|
$3,187.50
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.16 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$937.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,709.38
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
IP
|
$3,187.50
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,008.12 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,709.38
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.25
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
OP
|
$3,035.52
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$3,160.42 |
| Rate for Payer: Aetna Commercial |
$2,580.19
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cofinity Commercial |
$2,610.55
|
| Rate for Payer: Cofinity Commercial |
$2,124.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$2,731.97
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.19
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$2,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.86
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health SBD |
$1,912.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$72.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
IP
|
$3,035.52
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,912.38 |
| Max. Negotiated Rate |
$2,731.97 |
| Rate for Payer: Aetna Commercial |
$2,580.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.09
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cofinity Commercial |
$2,124.86
|
| Rate for Payer: Cofinity Commercial |
$2,610.55
|
| Rate for Payer: Healthscope Commercial |
$2,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.19
|
| Rate for Payer: PHP Commercial |
$2,580.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.86
|
| Rate for Payer: Priority Health SBD |
$1,912.38
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
OP
|
$3,035.52
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$2,580.19
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$937.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cofinity Commercial |
$2,124.86
|
| Rate for Payer: Cofinity Commercial |
$2,610.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$2,731.97
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.19
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$2,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,912.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$68.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
IP
|
$3,035.52
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,912.38 |
| Max. Negotiated Rate |
$2,731.97 |
| Rate for Payer: Aetna Commercial |
$2,580.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.09
|
| Rate for Payer: Cash Price |
$2,428.42
|
| Rate for Payer: Cofinity Commercial |
$2,124.86
|
| Rate for Payer: Cofinity Commercial |
$2,610.55
|
| Rate for Payer: Healthscope Commercial |
$2,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.19
|
| Rate for Payer: PHP Commercial |
$2,580.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.86
|
| Rate for Payer: Priority Health SBD |
$1,912.38
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.40
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$9.36
|
| Rate for Payer: Mclaren Medicare |
$17.12
|
| Rate for Payer: Meridian Medicaid |
$9.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$16.26
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$17.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Core |
$29.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Exchange |
$17.12
|
| Rate for Payer: UHC Medicare Advantage |
$17.63
|
| Rate for Payer: VA VA |
$17.12
|
|
|
HC BILE BODY FLUID
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC BILE BODY FLUID
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC BILIARY BRUSH BIOPSY
|
Facility
|
IP
|
$3,988.27
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
36100207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,512.61 |
| Max. Negotiated Rate |
$3,589.44 |
| Rate for Payer: Aetna Commercial |
$3,390.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,592.38
|
| Rate for Payer: Cash Price |
$3,190.62
|
| Rate for Payer: Cofinity Commercial |
$2,791.79
|
| Rate for Payer: Cofinity Commercial |
$3,429.91
|
| Rate for Payer: Healthscope Commercial |
$3,589.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,390.03
|
| Rate for Payer: PHP Commercial |
$3,390.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,791.79
|
| Rate for Payer: Priority Health SBD |
$2,512.61
|
|
|
HC BILIARY BRUSH BIOPSY
|
Facility
|
OP
|
$3,988.27
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
36100207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.54 |
| Max. Negotiated Rate |
$8,414.74 |
| Rate for Payer: Aetna Commercial |
$3,390.03
|
| Rate for Payer: Aetna Medicare |
$7,001.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,592.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,414.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,414.74
|
| Rate for Payer: BCBS Complete |
$3,866.74
|
| Rate for Payer: BCBS MAPPO |
$6,731.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.15
|
| Rate for Payer: BCN Medicare Advantage |
$6,731.79
|
| Rate for Payer: Cash Price |
$3,190.62
|
| Rate for Payer: Cash Price |
$3,190.62
|
| Rate for Payer: Cofinity Commercial |
$2,791.79
|
| Rate for Payer: Cofinity Commercial |
$3,429.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,731.79
|
| Rate for Payer: Healthscope Commercial |
$3,589.44
|
| Rate for Payer: Mclaren Medicaid |
$3,682.29
|
| Rate for Payer: Mclaren Medicare |
$6,731.79
|
| Rate for Payer: Meridian Medicaid |
$3,866.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,068.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,741.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,390.03
|
| Rate for Payer: PACE Medicare |
$6,395.20
|
| Rate for Payer: PACE SWMI |
$6,731.79
|
| Rate for Payer: PHP Commercial |
$3,390.03
|
| Rate for Payer: PHP Medicare Advantage |
$6,731.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,682.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,791.79
|
| Rate for Payer: Priority Health Medicare |
$6,731.79
|
| Rate for Payer: Priority Health SBD |
$2,512.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6,731.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.19
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,731.79
|
| Rate for Payer: UHC Exchange |
$266.54
|
| Rate for Payer: UHC Medicare Advantage |
$6,933.74
|
| Rate for Payer: VA VA |
$6,731.79
|
|
|
HC BILIARY DRAINAGE
|
Facility
|
OP
|
$459.89
|
|
| Hospital Charge Code |
36000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$413.90 |
| Rate for Payer: Aetna Commercial |
$390.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.93
|
| Rate for Payer: BCBS Complete |
$183.96
|
| Rate for Payer: Cash Price |
$367.91
|
| Rate for Payer: Cofinity Commercial |
$321.92
|
| Rate for Payer: Cofinity Commercial |
$395.51
|
| Rate for Payer: Healthscope Commercial |
$413.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$390.91
|
| Rate for Payer: PHP Commercial |
$390.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.92
|
| Rate for Payer: Priority Health SBD |
$289.73
|
|
|
HC BILIARY DRAINAGE
|
Facility
|
IP
|
$459.89
|
|
| Hospital Charge Code |
36000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$289.73 |
| Max. Negotiated Rate |
$413.90 |
| Rate for Payer: Aetna Commercial |
$390.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.93
|
| Rate for Payer: Cash Price |
$367.91
|
| Rate for Payer: Cofinity Commercial |
$321.92
|
| Rate for Payer: Cofinity Commercial |
$395.51
|
| Rate for Payer: Healthscope Commercial |
$413.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$390.91
|
| Rate for Payer: PHP Commercial |
$390.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.92
|
| Rate for Payer: Priority Health SBD |
$289.73
|
|
|
HC BILIARY DUCT BALLOON DILATATIO
|
Facility
|
OP
|
$1,819.24
|
|
| Hospital Charge Code |
36000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$727.70 |
| Max. Negotiated Rate |
$1,637.32 |
| Rate for Payer: Aetna Commercial |
$1,546.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.51
|
| Rate for Payer: BCBS Complete |
$727.70
|
| Rate for Payer: Cash Price |
$1,455.39
|
| Rate for Payer: Cofinity Commercial |
$1,273.47
|
| Rate for Payer: Cofinity Commercial |
$1,564.55
|
| Rate for Payer: Healthscope Commercial |
$1,637.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,546.35
|
| Rate for Payer: PHP Commercial |
$1,546.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.47
|
| Rate for Payer: Priority Health SBD |
$1,146.12
|
|
|
HC BILIARY DUCT BALLOON DILATATIO
|
Facility
|
IP
|
$1,819.24
|
|
| Hospital Charge Code |
36000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,146.12 |
| Max. Negotiated Rate |
$1,637.32 |
| Rate for Payer: Aetna Commercial |
$1,546.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.51
|
| Rate for Payer: Cash Price |
$1,455.39
|
| Rate for Payer: Cofinity Commercial |
$1,273.47
|
| Rate for Payer: Cofinity Commercial |
$1,564.55
|
| Rate for Payer: Healthscope Commercial |
$1,637.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,546.35
|
| Rate for Payer: PHP Commercial |
$1,546.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.47
|
| Rate for Payer: Priority Health SBD |
$1,146.12
|
|
