|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$228.50
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$205.65 |
| Rate for Payer: Aetna Commercial |
$194.22
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cofinity Commercial |
$159.95
|
| Rate for Payer: Cofinity Commercial |
$196.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$205.65
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.22
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$194.22
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.95
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$143.96
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$7.08
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health SBD |
$56.95
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.54
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.95
|
| Rate for Payer: UHC Exchange |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$13.34
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health SBD |
$56.95
|
|
|
HC CRP-SF
|
Facility
|
OP
|
$29.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$26.44 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$26.44
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.97
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$24.97
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$18.51
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$29.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$26.44 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.97
|
| Rate for Payer: PHP Commercial |
$24.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health SBD |
$18.51
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: BCBS Complete |
$280.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,112.82
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$1,001.54 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Medicare |
$409.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.62
|
| Rate for Payer: BCBS Complete |
$226.37
|
| Rate for Payer: BCBS MAPPO |
$394.10
|
| Rate for Payer: BCN Medicare Advantage |
$394.10
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cofinity Commercial |
$778.97
|
| Rate for Payer: Cofinity Commercial |
$957.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.10
|
| Rate for Payer: Healthscope Commercial |
$1,001.54
|
| Rate for Payer: Mclaren Medicaid |
$215.57
|
| Rate for Payer: Mclaren Medicare |
$394.10
|
| Rate for Payer: Meridian Medicaid |
$226.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$413.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.90
|
| Rate for Payer: PACE Medicare |
$374.40
|
| Rate for Payer: PACE SWMI |
$394.10
|
| Rate for Payer: PHP Commercial |
$945.90
|
| Rate for Payer: PHP Medicare Advantage |
$394.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.97
|
| Rate for Payer: Priority Health Medicare |
$394.10
|
| Rate for Payer: Priority Health SBD |
$701.08
|
| Rate for Payer: Railroad Medicare Medicare |
$394.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.10
|
| Rate for Payer: UHC Exchange |
$83.17
|
| Rate for Payer: UHC Medicare Advantage |
$405.92
|
| Rate for Payer: VA VA |
$394.10
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,112.82
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$701.08 |
| Max. Negotiated Rate |
$1,001.54 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.33
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cofinity Commercial |
$778.97
|
| Rate for Payer: Cofinity Commercial |
$957.03
|
| Rate for Payer: Healthscope Commercial |
$1,001.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.90
|
| Rate for Payer: PHP Commercial |
$945.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.97
|
| Rate for Payer: Priority Health SBD |
$701.08
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$257.46 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.07
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.07
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
|
|
HC CRUTCHES
|
Facility
|
IP
|
$124.22
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$105.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.74
|
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Cofinity Commercial |
$106.83
|
| Rate for Payer: Cofinity Commercial |
$86.95
|
| Rate for Payer: Healthscope Commercial |
$111.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.59
|
| Rate for Payer: PHP Commercial |
$105.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health SBD |
$78.26
|
|
|
HC CRUTCHES
|
Facility
|
OP
|
$124.22
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$105.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.74
|
| Rate for Payer: BCBS Complete |
$49.69
|
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Cofinity Commercial |
$106.83
|
| Rate for Payer: Cofinity Commercial |
$86.95
|
| Rate for Payer: Healthscope Commercial |
$111.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.59
|
| Rate for Payer: PHP Commercial |
$105.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health SBD |
$78.26
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
OP
|
$11,844.24
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.44 |
| Max. Negotiated Rate |
$27,732.34 |
| Rate for Payer: Aetna Commercial |
$10,067.60
|
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,698.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,496.77
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Cash Price |
$9,475.39
|
| Rate for Payer: Cash Price |
$9,475.39
|
| Rate for Payer: Cofinity Commercial |
$10,186.05
|
| Rate for Payer: Cofinity Commercial |
$8,290.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Healthscope Commercial |
$10,659.82
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,067.60
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Commercial |
$10,067.60
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,290.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,732.34
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Priority Health Narrow Network |
$22,185.87
|
| Rate for Payer: Priority Health SBD |
$7,461.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.28
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$438.44
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
IP
|
$11,844.24
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,461.87 |
| Max. Negotiated Rate |
$10,659.82 |
| Rate for Payer: Aetna Commercial |
$10,067.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,698.76
|
| Rate for Payer: Cash Price |
$9,475.39
|
| Rate for Payer: Cofinity Commercial |
$10,186.05
|
| Rate for Payer: Cofinity Commercial |
$8,290.97
|
| Rate for Payer: Healthscope Commercial |
$10,659.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,067.60
|
| Rate for Payer: PHP Commercial |
$10,067.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,290.97
|
| Rate for Payer: Priority Health SBD |
$7,461.87
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
OP
|
$10,323.30
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.28 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Commercial |
$8,774.80
|
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,710.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,818.41
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Cash Price |
$8,258.64
|
| Rate for Payer: Cash Price |
$8,258.64
|
| Rate for Payer: Cofinity Commercial |
$8,878.04
|
| Rate for Payer: Cofinity Commercial |
$7,226.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Healthscope Commercial |
$9,290.97
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,774.80
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Commercial |
$8,774.80
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,226.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Priority Health SBD |
$6,503.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.21
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$429.28
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
IP
|
$10,323.30
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,503.68 |
| Max. Negotiated Rate |
$9,290.97 |
| Rate for Payer: Aetna Commercial |
$8,774.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,710.14
|
| Rate for Payer: Cash Price |
$8,258.64
|
| Rate for Payer: Cofinity Commercial |
$7,226.31
|
| Rate for Payer: Cofinity Commercial |
$8,878.04
|
| Rate for Payer: Healthscope Commercial |
$9,290.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,774.80
|
| Rate for Payer: PHP Commercial |
$8,774.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,226.31
|
| Rate for Payer: Priority Health SBD |
$6,503.68
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
IP
|
$10,678.00
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,727.14 |
| Max. Negotiated Rate |
$9,610.20 |
| Rate for Payer: Aetna Commercial |
$9,076.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,940.70
|
| Rate for Payer: Cash Price |
$8,542.40
|
| Rate for Payer: Cofinity Commercial |
$7,474.60
|
| Rate for Payer: Cofinity Commercial |
$9,183.08
|
| Rate for Payer: Healthscope Commercial |
$9,610.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,076.30
|
| Rate for Payer: PHP Commercial |
$9,076.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,474.60
|
| Rate for Payer: Priority Health SBD |
$6,727.14
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
OP
|
$10,678.00
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.55 |
| Max. Negotiated Rate |
$9,610.20 |
| Rate for Payer: Aetna Commercial |
$9,076.30
|
| Rate for Payer: Aetna Medicare |
$5,419.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,940.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,513.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,513.48
|
| Rate for Payer: BCBS Complete |
$2,993.07
|
| Rate for Payer: BCBS MAPPO |
$5,210.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,210.78
|
| Rate for Payer: Cash Price |
$8,542.40
|
| Rate for Payer: Cash Price |
$8,542.40
|
| Rate for Payer: Cofinity Commercial |
$7,474.60
|
| Rate for Payer: Cofinity Commercial |
$9,183.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,210.78
|
| Rate for Payer: Healthscope Commercial |
$9,610.20
|
| Rate for Payer: Mclaren Medicaid |
$2,850.30
|
| Rate for Payer: Mclaren Medicare |
$5,210.78
|
| Rate for Payer: Meridian Medicaid |
$2,993.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,471.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,992.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,076.30
|
| Rate for Payer: PACE Medicare |
$4,950.24
|
| Rate for Payer: PACE SWMI |
$5,210.78
|
| Rate for Payer: PHP Commercial |
$9,076.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,210.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,850.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,474.60
|
| Rate for Payer: Priority Health Medicare |
$5,210.78
|
| Rate for Payer: Priority Health SBD |
$6,727.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5,210.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,210.78
|
| Rate for Payer: UHC Exchange |
$154.55
|
| Rate for Payer: UHC Medicare Advantage |
$5,367.10
|
| Rate for Payer: VA VA |
$5,210.78
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
IP
|
$3,457.80
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,178.41 |
| Max. Negotiated Rate |
$3,112.02 |
| Rate for Payer: Aetna Commercial |
$2,939.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.57
|
| Rate for Payer: Cash Price |
$2,766.24
|
| Rate for Payer: Cofinity Commercial |
$2,973.71
|
| Rate for Payer: Cofinity Commercial |
$2,420.46
|
| Rate for Payer: Healthscope Commercial |
$3,112.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,939.13
|
| Rate for Payer: PHP Commercial |
$2,939.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,420.46
|
| Rate for Payer: Priority Health SBD |
$2,178.41
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
OP
|
$3,457.80
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.12 |
| Max. Negotiated Rate |
$3,112.02 |
| Rate for Payer: Aetna Commercial |
$2,939.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.57
|
| Rate for Payer: BCBS Complete |
$1,383.12
|
| Rate for Payer: Cash Price |
$2,766.24
|
| Rate for Payer: Cofinity Commercial |
$2,420.46
|
| Rate for Payer: Cofinity Commercial |
$2,973.71
|
| Rate for Payer: Healthscope Commercial |
$3,112.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,939.13
|
| Rate for Payer: PHP Commercial |
$2,939.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,420.46
|
| Rate for Payer: Priority Health SBD |
$2,178.41
|
|
