|
HC CERTOLIZUMAB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.69 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.95
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$114.10
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health SBD |
$102.69
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health SBD |
$80.64
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health SBD |
$26.35
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.42
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.89
|
| Rate for Payer: UHC Core |
$18.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.74
|
| Rate for Payer: UHC Exchange |
$10.74
|
| Rate for Payer: UHC Medicare Advantage |
$11.06
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC CERVILENZ
|
Facility
|
OP
|
$167.34
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.94 |
| Max. Negotiated Rate |
$150.61 |
| Rate for Payer: Aetna Commercial |
$142.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.77
|
| Rate for Payer: BCBS Complete |
$66.94
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Cofinity Commercial |
$143.91
|
| Rate for Payer: Healthscope Commercial |
$150.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.24
|
| Rate for Payer: PHP Commercial |
$142.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.14
|
| Rate for Payer: Priority Health SBD |
$105.42
|
|
|
HC CERVILENZ
|
Facility
|
IP
|
$167.34
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$150.61 |
| Rate for Payer: Aetna Commercial |
$142.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.77
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Cofinity Commercial |
$143.91
|
| Rate for Payer: Healthscope Commercial |
$150.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.24
|
| Rate for Payer: PHP Commercial |
$142.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.14
|
| Rate for Payer: Priority Health SBD |
$105.42
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
OP
|
$138.02
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna Commercial |
$117.32
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.71
|
| 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 |
$99.78
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$96.61
|
| Rate for Payer: Cofinity Commercial |
$118.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$124.22
|
| 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 |
$117.32
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$117.32
|
| 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 |
$96.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.45
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$86.95
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
IP
|
$138.02
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$124.22 |
| Rate for Payer: Aetna Commercial |
$117.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.71
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$118.70
|
| Rate for Payer: Cofinity Commercial |
$96.61
|
| Rate for Payer: Healthscope Commercial |
$124.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.32
|
| Rate for Payer: PHP Commercial |
$117.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.61
|
| Rate for Payer: Priority Health SBD |
$86.95
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
OP
|
$762.46
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$304.98 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: BCBS Complete |
$304.98
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: UHC Core |
$564.22
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
IP
|
$762.46
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$480.35 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
OP
|
$21.88
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.60
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.32
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
IP
|
$21.88
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.60
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.32
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$996.54
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.82 |
| Max. Negotiated Rate |
$896.89 |
| Rate for Payer: Aetna Commercial |
$847.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.75
|
| Rate for Payer: Cash Price |
$797.23
|
| Rate for Payer: Cofinity Commercial |
$697.58
|
| Rate for Payer: Cofinity Commercial |
$857.02
|
| Rate for Payer: Healthscope Commercial |
$896.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$847.06
|
| Rate for Payer: PHP Commercial |
$847.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.58
|
| Rate for Payer: Priority Health SBD |
$627.82
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$996.54
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$896.89 |
| Rate for Payer: Aetna Commercial |
$847.06
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$300.69
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$797.23
|
| Rate for Payer: Cash Price |
$797.23
|
| Rate for Payer: Cofinity Commercial |
$857.02
|
| Rate for Payer: Cofinity Commercial |
$697.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$896.89
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$847.06
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$847.06
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.58
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health SBD |
$627.82
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$78.26
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
IP
|
$3,648.61
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,298.62 |
| Max. Negotiated Rate |
$3,283.75 |
| Rate for Payer: Aetna Commercial |
$3,101.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.60
|
| Rate for Payer: Cash Price |
$2,918.89
|
| Rate for Payer: Cofinity Commercial |
$2,554.03
|
| Rate for Payer: Cofinity Commercial |
$3,137.80
|
| Rate for Payer: Healthscope Commercial |
$3,283.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,101.32
|
| Rate for Payer: PHP Commercial |
$3,101.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,554.03
|
| Rate for Payer: Priority Health SBD |
$2,298.62
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
OP
|
$3,648.61
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,459.44 |
| Max. Negotiated Rate |
$3,283.75 |
| Rate for Payer: Aetna Commercial |
$3,101.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.60
|
| Rate for Payer: BCBS Complete |
$1,459.44
|
| Rate for Payer: Cash Price |
$2,918.89
|
| Rate for Payer: Cofinity Commercial |
$2,554.03
|
| Rate for Payer: Cofinity Commercial |
$3,137.80
|
| Rate for Payer: Healthscope Commercial |
$3,283.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,101.32
|
| Rate for Payer: PHP Commercial |
$3,101.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,554.03
|
| Rate for Payer: Priority Health SBD |
$2,298.62
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$290.92
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$247.28
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.96
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Cofinity Commercial |
$250.19
|
| Rate for Payer: Cofinity Commercial |
$203.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$261.83
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.28
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$247.28
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$183.28
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$290.92
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.28 |
| Max. Negotiated Rate |
$261.83 |
| Rate for Payer: Aetna Commercial |
$247.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.10
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Cofinity Commercial |
$203.64
|
| Rate for Payer: Cofinity Commercial |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$261.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.28
|
| Rate for Payer: PHP Commercial |
$247.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.64
|
| Rate for Payer: Priority Health SBD |
$183.28
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
IP
|
$1,076.22
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$678.02 |
| Max. Negotiated Rate |
$968.60 |
| Rate for Payer: Aetna Commercial |
$914.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.54
|
| Rate for Payer: Cash Price |
$860.98
|
| Rate for Payer: Cofinity Commercial |
$753.35
|
| Rate for Payer: Cofinity Commercial |
$925.55
|
| Rate for Payer: Healthscope Commercial |
$968.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.79
|
| Rate for Payer: PHP Commercial |
$914.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.35
|
| Rate for Payer: Priority Health SBD |
$678.02
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
OP
|
$1,076.22
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$992.77 |
| Rate for Payer: Aetna Commercial |
$914.79
|
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$673.63
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Cash Price |
$860.98
|
| Rate for Payer: Cash Price |
$860.98
|
| Rate for Payer: Cofinity Commercial |
$753.35
|
| Rate for Payer: Cofinity Commercial |
$925.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Healthscope Commercial |
$968.60
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.79
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Commercial |
$914.79
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$992.77
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health Narrow Network |
$794.22
|
| Rate for Payer: Priority Health SBD |
$678.02
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Exchange |
$74.00
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,140.44
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,978.48 |
| Max. Negotiated Rate |
$2,826.40 |
| Rate for Payer: Aetna Commercial |
$2,669.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.29
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cofinity Commercial |
$2,198.31
|
| Rate for Payer: Cofinity Commercial |
$2,700.78
|
| Rate for Payer: Healthscope Commercial |
$2,826.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,669.37
|
| Rate for Payer: PHP Commercial |
$2,669.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,198.31
|
| Rate for Payer: Priority Health SBD |
$1,978.48
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,140.44
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$2,826.40 |
| Rate for Payer: Aetna Commercial |
$2,669.37
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cofinity Commercial |
$2,700.78
|
| Rate for Payer: Cofinity Commercial |
$2,198.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$2,826.40
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,669.37
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$2,669.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,198.31
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health SBD |
$1,978.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$247.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,917.60
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.09 |
| Max. Negotiated Rate |
$1,725.84 |
| Rate for Payer: Aetna Commercial |
$1,629.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.44
|
| Rate for Payer: Cash Price |
$1,534.08
|
| Rate for Payer: Cofinity Commercial |
$1,342.32
|
| Rate for Payer: Cofinity Commercial |
$1,649.14
|
| Rate for Payer: Healthscope Commercial |
$1,725.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,629.96
|
| Rate for Payer: PHP Commercial |
$1,629.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,342.32
|
| Rate for Payer: Priority Health SBD |
$1,208.09
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,917.60
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$1,977.15 |
| Rate for Payer: Aetna Commercial |
$1,629.96
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.25
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$1,534.08
|
| Rate for Payer: Cash Price |
$1,534.08
|
| Rate for Payer: Cofinity Commercial |
$1,342.32
|
| Rate for Payer: Cofinity Commercial |
$1,649.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$1,725.84
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,629.96
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$1,629.96
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,342.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.15
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,581.72
|
| Rate for Payer: Priority Health SBD |
$1,208.09
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.79
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$131.63
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
