|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$26.53
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
OP
|
$26.53
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.24
|
| Rate for Payer: UHC Core |
$13.82
|
| Rate for Payer: UHC Exchange |
$10.43
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$507.83
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$901.26 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna Medicare |
$289.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$157.61
|
| Rate for Payer: BCN Commercial |
$157.61
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cofinity Advantage |
$355.48
|
| Rate for Payer: Cofinity Commercial |
$436.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$457.05
|
| Rate for Payer: Mclaren Medicaid |
$145.75
|
| Rate for Payer: Mclaren Medicare |
$278.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.62
|
| Rate for Payer: Meridian Medicaid |
$292.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$836.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.87
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: PHP Medicare Advantage |
$278.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$901.26
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health SBD |
$319.93
|
| Rate for Payer: Priority Health Tiered Network |
$721.01
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.09
|
| Rate for Payer: UHC Core |
$264.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$199.58
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$507.83
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$319.93 |
| Max. Negotiated Rate |
$457.05 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.09
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cofinity Advantage |
$355.48
|
| Rate for Payer: Cofinity Commercial |
$436.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.26
|
| Rate for Payer: Healthscope Commercial |
$457.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.87
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: Priority Health SBD |
$319.93
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$365.82
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$329.24 |
| Rate for Payer: Aetna Commercial |
$310.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.78
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cofinity Advantage |
$256.07
|
| Rate for Payer: Cofinity Commercial |
$314.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.66
|
| Rate for Payer: Healthscope Commercial |
$329.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.37
|
| Rate for Payer: PHP Commercial |
$310.95
|
| Rate for Payer: Priority Health SBD |
$230.47
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$365.82
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$901.26 |
| Rate for Payer: Aetna Commercial |
$310.95
|
| Rate for Payer: Aetna Medicare |
$289.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$52.36
|
| Rate for Payer: BCN Commercial |
$52.36
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cofinity Advantage |
$256.07
|
| Rate for Payer: Cofinity Commercial |
$314.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$329.24
|
| Rate for Payer: Mclaren Medicaid |
$145.75
|
| Rate for Payer: Mclaren Medicare |
$278.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.62
|
| Rate for Payer: Meridian Medicaid |
$292.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.95
|
| Rate for Payer: Nomi Health Commercial |
$836.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.37
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$310.95
|
| Rate for Payer: PHP Medicare Advantage |
$278.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$901.26
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health SBD |
$230.47
|
| Rate for Payer: Priority Health Tiered Network |
$721.01
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.78
|
| Rate for Payer: UHC Core |
$190.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$143.77
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$197.79
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Commercial |
$168.12
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$33.87
|
| Rate for Payer: BCN Commercial |
$33.87
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Advantage |
$138.45
|
| Rate for Payer: Cofinity Commercial |
$170.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$178.01
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$170.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$168.12
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$124.61
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.56
|
| Rate for Payer: UHC Core |
$103.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$77.73
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$197.79
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$178.01 |
| Rate for Payer: Aetna Commercial |
$168.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.56
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Advantage |
$138.45
|
| Rate for Payer: Cofinity Commercial |
$170.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Healthscope Commercial |
$178.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: PHP Commercial |
$168.12
|
| Rate for Payer: Priority Health SBD |
$124.61
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$61.55
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$52.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Advantage |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.16
|
| Rate for Payer: PHP Commercial |
$52.32
|
| Rate for Payer: Priority Health SBD |
$38.78
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$61.55
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$52.32
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$26.93
|
| Rate for Payer: BCN Commercial |
$26.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Advantage |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Mclaren Medicare |
$25.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Medicaid |
$26.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: Nomi Health Commercial |
$37.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.16
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$52.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.25
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health SBD |
$38.78
|
| Rate for Payer: Priority Health Tiered Network |
$20.20
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.88
|
| Rate for Payer: UHC Core |
$37.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.25
|
| Rate for Payer: UHC Exchange |
$37.88
|
| Rate for Payer: UHC Medicaid |
$13.21
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health SBD |
$37.17
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.11
|
| Rate for Payer: BCN Commercial |
$29.11
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Mclaren Medicare |
$27.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: Meridian Medicaid |
$28.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PACE Medicare |
$25.93
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: Priority Health Tiered Network |
$21.84
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.95
|
| Rate for Payer: UHC Core |
$40.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.30
|
| Rate for Payer: UHC Exchange |
$40.95
|
| Rate for Payer: UHC Medicaid |
$14.28
|
| Rate for Payer: UHCCP Medicaid |
$14.28
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
OP
|
$5,705.55
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,134.99 |
| Rate for Payer: Aetna Commercial |
$4,849.72
|
| Rate for Payer: Aetna Medicare |
$2,852.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,708.61
|
| Rate for Payer: BCBS Complete |
$2,282.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$4,564.44
|
| Rate for Payer: Cash Price |
$4,564.44
|
| Rate for Payer: Cofinity Advantage |
$3,993.89
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Healthscope Commercial |
$5,134.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,564.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,279.16
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: Priority Health SBD |
$3,594.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,708.61
|
| Rate for Payer: UHC Core |
$2,972.59
|
| Rate for Payer: UHC Exchange |
$2,242.28
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
IP
|
$5,705.55
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,594.50 |
| Max. Negotiated Rate |
$5,134.99 |
| Rate for Payer: Aetna Commercial |
$4,849.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,708.61
|
| Rate for Payer: Cash Price |
$4,564.44
|
| Rate for Payer: Cofinity Advantage |
$3,993.89
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Healthscope Commercial |
$5,134.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,279.16
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: Priority Health SBD |
$3,594.50
|
|
|
HC CATH CORONARY DRUG-DELIVERY
|
Facility
|
OP
|
$11,166.37
|
|
|
Service Code
|
HCPCS C9610
|
| Hospital Charge Code |
27200405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$10,049.73 |
| Rate for Payer: Aetna Commercial |
$9,491.41
|
| Rate for Payer: Aetna Medicare |
$5,583.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,258.14
|
| Rate for Payer: BCBS Complete |
$4,466.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$8,933.10
|
| Rate for Payer: Cash Price |
$8,933.10
|
| Rate for Payer: Cofinity Advantage |
$7,816.46
|
| Rate for Payer: Cofinity Commercial |
$9,603.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,933.10
|
| Rate for Payer: Healthscope Commercial |
$10,049.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,933.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,491.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,374.78
|
| Rate for Payer: PHP Commercial |
$9,491.41
|
| Rate for Payer: Priority Health SBD |
$7,034.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,258.14
|
| Rate for Payer: UHC Core |
$5,817.68
|
| Rate for Payer: UHC Exchange |
$4,388.38
|
|
|
HC CATH CORONARY DRUG-DELIVERY
|
Facility
|
IP
|
$11,166.37
|
|
|
Service Code
|
HCPCS C9610
|
| Hospital Charge Code |
27200405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,034.81 |
| Max. Negotiated Rate |
$10,049.73 |
| Rate for Payer: Aetna Commercial |
$9,491.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,258.14
|
| Rate for Payer: Cash Price |
$8,933.10
|
| Rate for Payer: Cofinity Advantage |
$7,816.46
|
| Rate for Payer: Cofinity Commercial |
$9,603.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,933.10
|
| Rate for Payer: Healthscope Commercial |
$10,049.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,491.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,374.78
|
| Rate for Payer: PHP Commercial |
$9,491.41
|
| Rate for Payer: Priority Health SBD |
$7,034.81
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
IP
|
$3,571.82
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,250.25 |
| Max. Negotiated Rate |
$3,214.64 |
| Rate for Payer: Aetna Commercial |
$3,036.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,321.68
|
| Rate for Payer: Cash Price |
$2,857.46
|
| Rate for Payer: Cofinity Advantage |
$2,500.27
|
| Rate for Payer: Cofinity Commercial |
$3,071.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,857.46
|
| Rate for Payer: Healthscope Commercial |
$3,214.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,036.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,678.86
|
| Rate for Payer: PHP Commercial |
$3,036.05
|
| Rate for Payer: Priority Health SBD |
$2,250.25
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
OP
|
$3,571.82
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,214.64 |
| Rate for Payer: Aetna Commercial |
$3,036.05
|
| Rate for Payer: Aetna Medicare |
$1,785.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,321.68
|
| Rate for Payer: BCBS Complete |
$1,428.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$2,857.46
|
| Rate for Payer: Cash Price |
$2,857.46
|
| Rate for Payer: Cofinity Advantage |
$2,500.27
|
| Rate for Payer: Cofinity Commercial |
$3,071.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,857.46
|
| Rate for Payer: Healthscope Commercial |
$3,214.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,857.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,036.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,678.86
|
| Rate for Payer: PHP Commercial |
$3,036.05
|
| Rate for Payer: Priority Health SBD |
$2,250.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,321.68
|
| Rate for Payer: UHC Core |
$1,860.92
|
| Rate for Payer: UHC Exchange |
$1,403.73
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
OP
|
$151.13
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna Medicare |
$75.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: BCBS Complete |
$60.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.23
|
| Rate for Payer: UHC Core |
$78.74
|
| Rate for Payer: UHC Exchange |
$59.39
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
IP
|
$151.13
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
OP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$713.53 |
| Rate for Payer: Aetna Commercial |
$673.89
|
| Rate for Payer: Aetna Medicare |
$396.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.33
|
| Rate for Payer: BCBS Complete |
$317.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Advantage |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$713.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.61
|
| Rate for Payer: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health SBD |
$499.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.33
|
| Rate for Payer: UHC Core |
$413.05
|
| Rate for Payer: UHC Exchange |
$311.57
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
IP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.47 |
| Max. Negotiated Rate |
$713.53 |
| Rate for Payer: Aetna Commercial |
$673.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.33
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Advantage |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$713.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.61
|
| Rate for Payer: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health SBD |
$499.47
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
IP
|
$1,562.73
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$984.52 |
| Max. Negotiated Rate |
$1,406.46 |
| Rate for Payer: Aetna Commercial |
$1,328.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.77
|
| Rate for Payer: Cash Price |
$1,250.18
|
| Rate for Payer: Cofinity Advantage |
$1,093.91
|
| Rate for Payer: Cofinity Commercial |
$1,343.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,250.18
|
| Rate for Payer: Healthscope Commercial |
$1,406.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,328.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.05
|
| Rate for Payer: PHP Commercial |
$1,328.32
|
| Rate for Payer: Priority Health SBD |
$984.52
|
|
