|
HC 5 FR SOLO 3CG POWER PICC
|
Facility
|
IP
|
$1,149.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.93 |
| Max. Negotiated Rate |
$1,034.19 |
| Rate for Payer: Aetna Commercial |
$976.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.91
|
| Rate for Payer: Cash Price |
$919.28
|
| Rate for Payer: Cofinity Advantage |
$804.37
|
| Rate for Payer: Cofinity Commercial |
$988.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.28
|
| Rate for Payer: Healthscope Commercial |
$1,034.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$861.83
|
| Rate for Payer: PHP Commercial |
$976.74
|
| Rate for Payer: Priority Health SBD |
$723.93
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
OP
|
$995.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.35 |
| Max. Negotiated Rate |
$896.21 |
| Rate for Payer: Aetna Commercial |
$846.42
|
| Rate for Payer: Aetna Medicare |
$497.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.26
|
| Rate for Payer: BCBS Complete |
$398.32
|
| Rate for Payer: Cash Price |
$796.63
|
| Rate for Payer: Cofinity Advantage |
$697.05
|
| Rate for Payer: Cofinity Commercial |
$856.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.63
|
| Rate for Payer: Healthscope Commercial |
$896.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.84
|
| Rate for Payer: PHP Commercial |
$846.42
|
| Rate for Payer: Priority Health SBD |
$627.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.26
|
| Rate for Payer: UHC Core |
$518.81
|
| Rate for Payer: UHC Exchange |
$391.35
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
IP
|
$995.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.35 |
| Max. Negotiated Rate |
$896.21 |
| Rate for Payer: Aetna Commercial |
$846.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.26
|
| Rate for Payer: Cash Price |
$796.63
|
| Rate for Payer: Cofinity Advantage |
$697.05
|
| Rate for Payer: Cofinity Commercial |
$856.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.63
|
| Rate for Payer: Healthscope Commercial |
$896.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.84
|
| Rate for Payer: PHP Commercial |
$846.42
|
| Rate for Payer: Priority Health SBD |
$627.35
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
OP
|
$1,253.58
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.66 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Aetna Commercial |
$1,065.54
|
| Rate for Payer: Aetna Medicare |
$626.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.83
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: Cash Price |
$1,002.86
|
| Rate for Payer: Cofinity Advantage |
$877.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.86
|
| Rate for Payer: Healthscope Commercial |
$1,128.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,002.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$940.18
|
| Rate for Payer: PHP Commercial |
$1,065.54
|
| Rate for Payer: Priority Health SBD |
$789.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.83
|
| Rate for Payer: UHC Core |
$653.12
|
| Rate for Payer: UHC Exchange |
$492.66
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
IP
|
$1,253.58
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.76 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Aetna Commercial |
$1,065.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.83
|
| Rate for Payer: Cash Price |
$1,002.86
|
| Rate for Payer: Cofinity Advantage |
$877.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.86
|
| Rate for Payer: Healthscope Commercial |
$1,128.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$940.18
|
| Rate for Payer: PHP Commercial |
$1,065.54
|
| Rate for Payer: Priority Health SBD |
$789.76
|
|
|
HC 5 FR TL SOLO MAX POWER PICC
|
Facility
|
IP
|
$1,086.31
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.38 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.10
|
| Rate for Payer: Cash Price |
$869.05
|
| Rate for Payer: Cofinity Advantage |
$760.42
|
| Rate for Payer: Cofinity Commercial |
$934.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.05
|
| Rate for Payer: Healthscope Commercial |
$977.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$814.73
|
| Rate for Payer: PHP Commercial |
$923.36
|
| Rate for Payer: Priority Health SBD |
$684.38
|
|
|
HC 5 FR TL SOLO MAX POWER PICC
|
Facility
|
OP
|
$1,086.31
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.92 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Aetna Medicare |
$543.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.10
|
| Rate for Payer: BCBS Complete |
$434.52
|
| Rate for Payer: Cash Price |
$869.05
|
| Rate for Payer: Cofinity Advantage |
$760.42
|
| Rate for Payer: Cofinity Commercial |
$934.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.05
|
| Rate for Payer: Healthscope Commercial |
$977.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$869.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$814.73
|
| Rate for Payer: PHP Commercial |
$923.36
|
| Rate for Payer: Priority Health SBD |
$684.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.10
|
| Rate for Payer: UHC Core |
$565.97
|
| Rate for Payer: UHC Exchange |
$426.92
|
|
|
HC 6 FR SOLO 3CG POWER PICC
|
Facility
|
OP
|
$1,253.58
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.66 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Aetna Commercial |
$1,065.54
|
| Rate for Payer: Aetna Medicare |
$626.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.83
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: Cash Price |
$1,002.86
|
| Rate for Payer: Cofinity Advantage |
$877.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.86
|
| Rate for Payer: Healthscope Commercial |
$1,128.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,002.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$940.18
|
| Rate for Payer: PHP Commercial |
$1,065.54
|
| Rate for Payer: Priority Health SBD |
$789.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.83
|
| Rate for Payer: UHC Core |
$653.12
|
| Rate for Payer: UHC Exchange |
$492.66
|
|
|
HC 6 FR SOLO 3CG POWER PICC
|
Facility
|
IP
|
$1,253.58
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.76 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Aetna Commercial |
$1,065.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.83
|
| Rate for Payer: Cash Price |
$1,002.86
|
| Rate for Payer: Cofinity Advantage |
$877.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.86
|
| Rate for Payer: Healthscope Commercial |
$1,128.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$940.18
|
| Rate for Payer: PHP Commercial |
$1,065.54
|
| Rate for Payer: Priority Health SBD |
$789.76
|
|
|
HC 6FR SOLO POWER PICC
|
Facility
|
IP
|
$1,086.31
|
|
| Hospital Charge Code |
27200109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.38 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.10
|
| Rate for Payer: Cash Price |
$869.05
|
| Rate for Payer: Cofinity Advantage |
$760.42
|
| Rate for Payer: Cofinity Commercial |
$934.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.05
|
| Rate for Payer: Healthscope Commercial |
$977.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$814.73
|
| Rate for Payer: PHP Commercial |
$923.36
|
| Rate for Payer: Priority Health SBD |
$684.38
|
|
|
HC 6FR SOLO POWER PICC
|
Facility
|
OP
|
$1,086.31
|
|
| Hospital Charge Code |
27200109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.92 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Aetna Medicare |
$543.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.10
|
| Rate for Payer: BCBS Complete |
$434.52
|
| Rate for Payer: Cash Price |
$869.05
|
| Rate for Payer: Cofinity Advantage |
$760.42
|
| Rate for Payer: Cofinity Commercial |
$934.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.05
|
| Rate for Payer: Healthscope Commercial |
$977.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$869.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$814.73
|
| Rate for Payer: PHP Commercial |
$923.36
|
| Rate for Payer: Priority Health SBD |
$684.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.10
|
| Rate for Payer: UHC Core |
$565.97
|
| Rate for Payer: UHC Exchange |
$426.92
|
|
|
HC 8X8 WAFER
|
Facility
|
OP
|
$75.52
|
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: Aetna Commercial |
$64.19
|
| Rate for Payer: Aetna Medicare |
$37.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.09
|
| Rate for Payer: BCBS Complete |
$30.21
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Advantage |
$52.86
|
| Rate for Payer: Cofinity Commercial |
$64.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$67.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.64
|
| Rate for Payer: PHP Commercial |
$64.19
|
| Rate for Payer: Priority Health SBD |
$47.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.09
|
| Rate for Payer: UHC Core |
$39.35
|
| Rate for Payer: UHC Exchange |
$29.68
|
|
|
HC 8X8 WAFER
|
Facility
|
IP
|
$75.52
|
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: Aetna Commercial |
$64.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.09
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Advantage |
$52.86
|
| Rate for Payer: Cofinity Commercial |
$64.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$67.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.64
|
| Rate for Payer: PHP Commercial |
$64.19
|
| Rate for Payer: Priority Health SBD |
$47.58
|
|
|
HC A1AT PROTEOTYPE
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health SBD |
$31.42
|
|
|
HC A1AT PROTEOTYPE
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$25.69
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC A1AT PROTEOTYPE CMPT
|
Facility
|
IP
|
$24.06
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
30100611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.64
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$21.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.05
|
| Rate for Payer: PHP Commercial |
$20.45
|
| Rate for Payer: Priority Health SBD |
$15.16
|
|
|
HC A1AT PROTEOTYPE CMPT
|
Facility
|
OP
|
$24.06
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
30100611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$21.65
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Mclaren Medicare |
$13.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: Meridian Medicaid |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.45
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.05
|
| Rate for Payer: PACE Medicare |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$20.45
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.44
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health SBD |
$15.16
|
| Rate for Payer: Priority Health Tiered Network |
$10.75
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Core |
$20.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.44
|
| Rate for Payer: UHC Exchange |
$20.16
|
| Rate for Payer: UHC Medicaid |
$7.03
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
| Rate for Payer: VA VA |
$13.44
|
|
|
HC ABDOMINAL HYSTERECT (OB SURGER
|
Facility
|
IP
|
$2,616.68
|
|
| Hospital Charge Code |
36000002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.51 |
| Max. Negotiated Rate |
$2,355.01 |
| Rate for Payer: Aetna Commercial |
$2,224.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.84
|
| Rate for Payer: Cash Price |
$2,093.34
|
| Rate for Payer: Cofinity Advantage |
$1,831.68
|
| Rate for Payer: Cofinity Commercial |
$2,250.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.34
|
| Rate for Payer: Healthscope Commercial |
$2,355.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,962.51
|
| Rate for Payer: PHP Commercial |
$2,224.18
|
| Rate for Payer: Priority Health SBD |
$1,648.51
|
|
|
HC ABDOMINAL HYSTERECT (OB SURGER
|
Facility
|
OP
|
$2,616.68
|
|
| Hospital Charge Code |
36000002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,046.67 |
| Max. Negotiated Rate |
$2,355.01 |
| Rate for Payer: Aetna Commercial |
$2,224.18
|
| Rate for Payer: Aetna Medicare |
$1,308.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.84
|
| Rate for Payer: BCBS Complete |
$1,046.67
|
| Rate for Payer: Cash Price |
$2,093.34
|
| Rate for Payer: Cofinity Advantage |
$1,831.68
|
| Rate for Payer: Cofinity Commercial |
$2,250.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.34
|
| Rate for Payer: Healthscope Commercial |
$2,355.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,093.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,962.51
|
| Rate for Payer: PHP Commercial |
$2,224.18
|
| Rate for Payer: Priority Health SBD |
$1,648.51
|
|
|
HC ABDOMINAL PARACENTESIS W/O IMAGE GUIDE
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,827.00 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna Commercial |
$2,465.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,885.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cofinity Advantage |
$2,030.00
|
| Rate for Payer: Cofinity Commercial |
$2,494.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,320.00
|
| Rate for Payer: Healthscope Commercial |
$2,610.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,465.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,175.00
|
| Rate for Payer: PHP Commercial |
$2,465.00
|
| Rate for Payer: Priority Health SBD |
$1,827.00
|
|
|
HC ABDOMINAL PARACENTESIS W/O IMAGE GUIDE
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$2,465.00
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,885.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$570.17
|
| Rate for Payer: BCN Commercial |
$570.17
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cofinity Advantage |
$2,030.00
|
| Rate for Payer: Cofinity Commercial |
$2,494.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,320.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$2,610.00
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,465.00
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,175.00
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$2,465.00
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$1,827.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,885.00
|
| Rate for Payer: UHC Core |
$1,510.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$1,139.70
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC ABDOMINAL STERILIZE (OB SURGER
|
Facility
|
IP
|
$1,608.48
|
|
| Hospital Charge Code |
36000003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,013.34 |
| Max. Negotiated Rate |
$1,447.63 |
| Rate for Payer: Aetna Commercial |
$1,367.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.51
|
| Rate for Payer: Cash Price |
$1,286.78
|
| Rate for Payer: Cofinity Advantage |
$1,125.94
|
| Rate for Payer: Cofinity Commercial |
$1,383.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,286.78
|
| Rate for Payer: Healthscope Commercial |
$1,447.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,367.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.36
|
| Rate for Payer: PHP Commercial |
$1,367.21
|
| Rate for Payer: Priority Health SBD |
$1,013.34
|
|
|
HC ABDOMINAL STERILIZE (OB SURGER
|
Facility
|
OP
|
$1,608.48
|
|
| Hospital Charge Code |
36000003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.39 |
| Max. Negotiated Rate |
$1,447.63 |
| Rate for Payer: Aetna Commercial |
$1,367.21
|
| Rate for Payer: Aetna Medicare |
$804.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.51
|
| Rate for Payer: BCBS Complete |
$643.39
|
| Rate for Payer: Cash Price |
$1,286.78
|
| Rate for Payer: Cofinity Advantage |
$1,125.94
|
| Rate for Payer: Cofinity Commercial |
$1,383.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,286.78
|
| Rate for Payer: Healthscope Commercial |
$1,447.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,286.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,367.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.36
|
| Rate for Payer: PHP Commercial |
$1,367.21
|
| Rate for Payer: Priority Health SBD |
$1,013.34
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS
|
Facility
|
OP
|
$4,104.76
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100603
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Commercial |
$3,489.05
|
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,668.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Cash Price |
$3,283.81
|
| Rate for Payer: Cash Price |
$3,283.81
|
| Rate for Payer: Cofinity Advantage |
$2,873.33
|
| Rate for Payer: Cofinity Commercial |
$3,530.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,283.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Healthscope Commercial |
$3,694.28
|
| Rate for Payer: Mclaren Medicaid |
$1,017.60
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,489.05
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,078.57
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Commercial |
$3,489.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health SBD |
$2,586.00
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS
|
Facility
|
IP
|
$4,104.76
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100603
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,586.00 |
| Max. Negotiated Rate |
$3,694.28 |
| Rate for Payer: Aetna Commercial |
$3,489.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,668.09
|
| Rate for Payer: Cash Price |
$3,283.81
|
| Rate for Payer: Cofinity Advantage |
$2,873.33
|
| Rate for Payer: Cofinity Commercial |
$3,530.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,283.81
|
| Rate for Payer: Healthscope Commercial |
$3,694.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,489.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,078.57
|
| Rate for Payer: PHP Commercial |
$3,489.05
|
| Rate for Payer: Priority Health SBD |
$2,586.00
|
|
