|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.13 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.12
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$454.59
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| 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
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.19 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Commercial |
$3,052.50
|
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,334.27
|
| 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 |
$2,602.79
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$2,513.83
|
| Rate for Payer: Cofinity Commercial |
$3,088.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Healthscope Commercial |
$3,232.06
|
| 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 |
$3,052.50
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Commercial |
$3,052.50
|
| 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 |
$2,513.83
|
| 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 |
$2,262.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.21
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$360.19
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,262.44 |
| Max. Negotiated Rate |
$3,232.06 |
| Rate for Payer: Aetna Commercial |
$3,052.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,334.27
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$2,513.83
|
| Rate for Payer: Cofinity Commercial |
$3,088.41
|
| Rate for Payer: Healthscope Commercial |
$3,232.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,052.50
|
| Rate for Payer: PHP Commercial |
$3,052.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,513.83
|
| Rate for Payer: Priority Health SBD |
$2,262.44
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.95 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$968.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Cofinity Commercial |
$1,334.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$1,200.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.74
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$317.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,200.78 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.90
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,334.20
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health SBD |
$1,200.78
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,906.25 |
| Max. Negotiated Rate |
$7,008.93 |
| Rate for Payer: Aetna Commercial |
$6,619.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,062.00
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$5,451.39
|
| Rate for Payer: Cofinity Commercial |
$6,697.42
|
| Rate for Payer: Healthscope Commercial |
$7,008.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: PHP Commercial |
$6,619.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: Priority Health SBD |
$4,906.25
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$7,008.93 |
| Rate for Payer: Aetna Commercial |
$6,619.54
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,062.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$6,697.42
|
| Rate for Payer: Cofinity Commercial |
$5,451.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$7,008.93
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,619.54
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$4,906.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$47.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$32.29
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Cofinity Commercial |
$148.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$190.51
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$179.93
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$133.36
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$40.60
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.36 |
| Max. Negotiated Rate |
$190.51 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.59
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$148.18
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Healthscope Commercial |
$190.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: PHP Commercial |
$179.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: Priority Health SBD |
$133.36
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$644.30 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.52
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$251.58
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.30
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.44
|
| Rate for Payer: Priority Health SBD |
$226.42
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.61
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$251.58
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health SBD |
$226.42
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$33.89
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.03
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Healthscope Commercial |
$30.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.81
|
| Rate for Payer: PHP Commercial |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.72
|
| Rate for Payer: Priority Health SBD |
$21.35
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$33.89
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.03
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Healthscope Commercial |
$30.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.81
|
| Rate for Payer: PHP Commercial |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.72
|
| Rate for Payer: Priority Health SBD |
$21.35
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$24.80
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$15.62
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$24.80
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$15.62
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$24.80
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$15.62
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$24.80
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$15.62
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,477.80
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$9,573.02 |
| Rate for Payer: Aetna Commercial |
$3,806.13
|
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,910.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,356.92
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cofinity Commercial |
$3,850.91
|
| Rate for Payer: Cofinity Commercial |
$3,134.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Healthscope Commercial |
$4,030.02
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,806.13
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Commercial |
$3,806.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,134.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,573.02
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,658.42
|
| Rate for Payer: Priority Health SBD |
$2,821.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,477.80
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,821.01 |
| Max. Negotiated Rate |
$4,030.02 |
| Rate for Payer: Aetna Commercial |
$3,806.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,910.57
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cofinity Commercial |
$3,134.46
|
| Rate for Payer: Cofinity Commercial |
$3,850.91
|
| Rate for Payer: Healthscope Commercial |
$4,030.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,806.13
|
| Rate for Payer: PHP Commercial |
$3,806.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,134.46
|
| Rate for Payer: Priority Health SBD |
$2,821.01
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health SBD |
$28.04
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$44.50
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.99
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$15.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$121.18
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$109.06 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.77
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cofinity Commercial |
$104.21
|
| Rate for Payer: Cofinity Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$109.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.00
|
| Rate for Payer: PHP Commercial |
$103.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.83
|
| Rate for Payer: Priority Health SBD |
$76.34
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$121.18
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$317.39 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.77
|
| Rate for Payer: BCBS Complete |
$48.47
|
| Rate for Payer: BCBS Trust/PPO |
$317.39
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cofinity Commercial |
$84.83
|
| Rate for Payer: Cofinity Commercial |
$104.21
|
| Rate for Payer: Healthscope Commercial |
$109.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.00
|
| Rate for Payer: PHP Commercial |
$103.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.83
|
| Rate for Payer: Priority Health SBD |
$76.34
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.27
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$36.91
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health SBD |
$33.22
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$101.44 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.27
|
| Rate for Payer: BCBS Complete |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$101.44
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$36.91
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health SBD |
$33.22
|
|
