|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
IP
|
$413.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.81 |
| Max. Negotiated Rate |
$372.59 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.09
|
| Rate for Payer: Cash Price |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$289.79
|
| Rate for Payer: Cofinity Commercial |
$356.03
|
| Rate for Payer: Healthscope Commercial |
$372.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.89
|
| Rate for Payer: PHP Commercial |
$351.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.79
|
| Rate for Payer: Priority Health SBD |
$260.81
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
OP
|
$413.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$372.59 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.09
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$289.79
|
| Rate for Payer: Cofinity Commercial |
$356.03
|
| Rate for Payer: Healthscope Commercial |
$372.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.89
|
| Rate for Payer: PHP Commercial |
$351.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.79
|
| Rate for Payer: Priority Health SBD |
$260.81
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
IP
|
$518.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.96 |
| Max. Negotiated Rate |
$467.09 |
| Rate for Payer: Aetna Commercial |
$441.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.34
|
| Rate for Payer: Cash Price |
$415.19
|
| Rate for Payer: Cofinity Commercial |
$363.29
|
| Rate for Payer: Cofinity Commercial |
$446.33
|
| Rate for Payer: Healthscope Commercial |
$467.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.14
|
| Rate for Payer: PHP Commercial |
$441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.29
|
| Rate for Payer: Priority Health SBD |
$326.96
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
OP
|
$518.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.60 |
| Max. Negotiated Rate |
$467.09 |
| Rate for Payer: Aetna Commercial |
$441.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.34
|
| Rate for Payer: BCBS Complete |
$207.60
|
| Rate for Payer: Cash Price |
$415.19
|
| Rate for Payer: Cofinity Commercial |
$363.29
|
| Rate for Payer: Cofinity Commercial |
$446.33
|
| Rate for Payer: Healthscope Commercial |
$467.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.14
|
| Rate for Payer: PHP Commercial |
$441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.29
|
| Rate for Payer: Priority Health SBD |
$326.96
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
IP
|
$728.99
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.26 |
| Max. Negotiated Rate |
$656.09 |
| Rate for Payer: Aetna Commercial |
$619.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.84
|
| Rate for Payer: Cash Price |
$583.19
|
| Rate for Payer: Cofinity Commercial |
$510.29
|
| Rate for Payer: Cofinity Commercial |
$626.93
|
| Rate for Payer: Healthscope Commercial |
$656.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$619.64
|
| Rate for Payer: PHP Commercial |
$619.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.29
|
| Rate for Payer: Priority Health SBD |
$459.26
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
OP
|
$728.99
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$656.09 |
| Rate for Payer: Aetna Commercial |
$619.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.84
|
| Rate for Payer: BCBS Complete |
$291.60
|
| Rate for Payer: Cash Price |
$583.19
|
| Rate for Payer: Cofinity Commercial |
$510.29
|
| Rate for Payer: Cofinity Commercial |
$626.93
|
| Rate for Payer: Healthscope Commercial |
$656.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$619.64
|
| Rate for Payer: PHP Commercial |
$619.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.29
|
| Rate for Payer: Priority Health SBD |
$459.26
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
OP
|
$777.75
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$699.98 |
| Rate for Payer: Aetna Commercial |
$661.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.54
|
| Rate for Payer: BCBS Complete |
$311.10
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Healthscope Commercial |
$699.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$661.09
|
| Rate for Payer: PHP Commercial |
$661.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.42
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
IP
|
$777.75
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.98 |
| Max. Negotiated Rate |
$699.98 |
| Rate for Payer: Aetna Commercial |
$661.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.54
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Healthscope Commercial |
$699.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$661.09
|
| Rate for Payer: PHP Commercial |
$661.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.42
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
OP
|
$833.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$750.59 |
| Rate for Payer: Aetna Commercial |
$708.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.09
|
| Rate for Payer: BCBS Complete |
$333.60
|
| Rate for Payer: Cash Price |
$667.19
|
| Rate for Payer: Cofinity Commercial |
$583.79
|
| Rate for Payer: Cofinity Commercial |
$717.23
|
| Rate for Payer: Healthscope Commercial |
$750.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$708.89
|
| Rate for Payer: PHP Commercial |
$708.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.79
|
| Rate for Payer: Priority Health SBD |
$525.41
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
IP
|
$833.99
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.41 |
| Max. Negotiated Rate |
$750.59 |
| Rate for Payer: Aetna Commercial |
$708.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.09
|
| Rate for Payer: Cash Price |
$667.19
|
| Rate for Payer: Cofinity Commercial |
$583.79
|
| Rate for Payer: Cofinity Commercial |
$717.23
|
| Rate for Payer: Healthscope Commercial |
$750.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$708.89
|
| Rate for Payer: PHP Commercial |
$708.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.79
|
| Rate for Payer: Priority Health SBD |
$525.41
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
IP
|
$938.99
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.56 |
| Max. Negotiated Rate |
$845.09 |
| Rate for Payer: Aetna Commercial |
$798.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.34
|
| Rate for Payer: Cash Price |
$751.19
|
| Rate for Payer: Cofinity Commercial |
$657.29
|
| Rate for Payer: Cofinity Commercial |
$807.53
|
| Rate for Payer: Healthscope Commercial |
$845.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.14
|
| Rate for Payer: PHP Commercial |
$798.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.29
|
| Rate for Payer: Priority Health SBD |
$591.56
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$938.99
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.60 |
| Max. Negotiated Rate |
$845.09 |
| Rate for Payer: Aetna Commercial |
$798.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.34
|
| Rate for Payer: BCBS Complete |
$375.60
|
| Rate for Payer: Cash Price |
$751.19
|
| Rate for Payer: Cofinity Commercial |
$657.29
|
| Rate for Payer: Cofinity Commercial |
$807.53
|
| Rate for Payer: Healthscope Commercial |
$845.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.14
|
| Rate for Payer: PHP Commercial |
$798.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.29
|
| Rate for Payer: Priority Health SBD |
$591.56
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$244.93 |
| Max. Negotiated Rate |
$349.90 |
| Rate for Payer: Aetna Commercial |
$330.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.71
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$334.35
|
| Rate for Payer: Cofinity Commercial |
$272.15
|
| Rate for Payer: Healthscope Commercial |
$349.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: PHP Commercial |
$330.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: Priority Health SBD |
$244.93
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$349.90 |
| Rate for Payer: Aetna Commercial |
$330.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.71
|
| Rate for Payer: BCBS Complete |
$155.51
|
| Rate for Payer: BCBS Trust/PPO |
$219.53
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$272.15
|
| Rate for Payer: Cofinity Commercial |
$334.35
|
| Rate for Payer: Healthscope Commercial |
$349.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: PHP Commercial |
$330.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: Priority Health SBD |
$244.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.24
|
| Rate for Payer: UHC Exchange |
$55.67
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$116.20
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health SBD |
$104.58
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: BCBS Complete |
$19.99
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$27.26
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$116.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Mclaren Medicaid |
$19.04
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Medicaid |
$19.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health SBD |
$104.58
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.77
|
| Rate for Payer: UHC Core |
$54.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.81
|
| Rate for Payer: UHC Exchange |
$34.81
|
| Rate for Payer: UHC Medicare Advantage |
$35.85
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.55
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$63.05
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health SBD |
$56.74
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$63.05
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Medicaid |
$7.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health SBD |
$56.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.94
|
| Rate for Payer: UHC Core |
$22.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Exchange |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.38
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.34
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: Priority Health SBD |
$65.27
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna Medicare |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health SBD |
$65.27
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.51
|
| Rate for Payer: UHC Core |
$23.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$14.17
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.40
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$116.74
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Healthscope Commercial |
$150.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: PHP Commercial |
$141.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health SBD |
$105.07
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$52.06
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Cofinity Commercial |
$116.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$150.09
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$141.75
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$105.07
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$39.29
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.68 |
| Max. Negotiated Rate |
$1,540.78 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.12
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.78
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Cofinity Commercial |
$454.59
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health SBD |
$409.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.55
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$128.68
|
|
