|
HC BETA 2 GP1 AB IGM
|
Facility
|
IP
|
$51.40
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$46.26 |
| Rate for Payer: Aetna Commercial |
$43.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.41
|
| Rate for Payer: Cash Price |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$35.98
|
| Rate for Payer: Cofinity Commercial |
$44.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.12
|
| Rate for Payer: Healthscope Commercial |
$46.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.69
|
| Rate for Payer: PHP Commercial |
$43.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.41
|
| Rate for Payer: Priority Health SBD |
$32.38
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$708.73 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.22
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS MAPPO |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: BCN Medicare Advantage |
$16.18
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$8.67
|
| Rate for Payer: Mclaren Medicare |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.99
|
| Rate for Payer: Meridian Medicaid |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: PACE Medicare |
$15.37
|
| Rate for Payer: PACE SWMI |
$16.18
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: PHP Medicare Advantage |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.64
|
| Rate for Payer: Priority Health Medicare |
$16.18
|
| Rate for Payer: Priority Health Narrow Network |
$13.31
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: Railroad Medicare Medicare |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.42
|
| Rate for Payer: UHC Core |
$708.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.18
|
| Rate for Payer: UHC Exchange |
$708.73
|
| Rate for Payer: UHC Medicare Advantage |
$16.18
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$16.18
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health SBD |
$26.88
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$962.80 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.24
|
| Rate for Payer: BCN Commercial |
$7.24
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$12.26
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.17
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$6.54
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Core |
$962.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Exchange |
$962.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.60
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$612.78
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$520.86
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$526.99
|
| Rate for Payer: Cofinity Commercial |
$428.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$551.50
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.86
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$520.86
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$386.05
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.40
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$612.78
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.05 |
| Max. Negotiated Rate |
$551.50 |
| Rate for Payer: Aetna Commercial |
$520.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.31
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$428.95
|
| Rate for Payer: Cofinity Commercial |
$526.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.22
|
| Rate for Payer: Healthscope Commercial |
$551.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.86
|
| Rate for Payer: PHP Commercial |
$520.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.31
|
| Rate for Payer: Priority Health SBD |
$386.05
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$738.48
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$627.71
|
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$87.88
|
| Rate for Payer: BCN Commercial |
$87.88
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cofinity Commercial |
$635.09
|
| Rate for Payer: Cofinity Commercial |
$516.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$664.63
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.71
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$627.71
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Priority Health SBD |
$465.24
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$738.48
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.24 |
| Max. Negotiated Rate |
$664.63 |
| Rate for Payer: Aetna Commercial |
$627.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.01
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cofinity Commercial |
$516.94
|
| Rate for Payer: Cofinity Commercial |
$635.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.78
|
| Rate for Payer: Healthscope Commercial |
$664.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.71
|
| Rate for Payer: PHP Commercial |
$627.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.01
|
| Rate for Payer: Priority Health SBD |
$465.24
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$116.88
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$121.66 |
| Rate for Payer: Aetna Commercial |
$99.35
|
| Rate for Payer: Aetna Medicare |
$58.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.97
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$63.37
|
| Rate for Payer: BCN Commercial |
$63.37
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cofinity Commercial |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$81.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.50
|
| Rate for Payer: Healthscope Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.35
|
| Rate for Payer: PHP Commercial |
$99.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.66
|
| Rate for Payer: Priority Health Narrow Network |
$97.33
|
| Rate for Payer: Priority Health SBD |
$73.63
|
| Rate for Payer: UHC Exchange |
$86.49
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$116.88
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$105.19 |
| Rate for Payer: Aetna Commercial |
$99.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.97
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cofinity Commercial |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$81.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.50
|
| Rate for Payer: Healthscope Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.35
|
| Rate for Payer: PHP Commercial |
$99.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.97
|
| Rate for Payer: Priority Health SBD |
$73.63
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
OP
|
$456.96
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$93.83
|
| Rate for Payer: BCN Commercial |
$93.83
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Cofinity Commercial |
$319.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$411.26
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Priority Health SBD |
$287.88
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.02
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
IP
|
$456.96
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.88 |
| Max. Negotiated Rate |
$411.26 |
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.02
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$319.87
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Healthscope Commercial |
$411.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health SBD |
$287.88
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$14,483.45
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9,124.57 |
| Max. Negotiated Rate |
$13,035.10 |
| Rate for Payer: Aetna Commercial |
$12,310.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,414.24
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cofinity Commercial |
$10,138.42
|
| Rate for Payer: Cofinity Commercial |
$12,455.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,586.76
|
| Rate for Payer: Healthscope Commercial |
$13,035.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,310.93
|
| Rate for Payer: PHP Commercial |
$12,310.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,414.24
|
| Rate for Payer: Priority Health SBD |
$9,124.57
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$14,483.45
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.71 |
| Max. Negotiated Rate |
$20,210.02 |
| Rate for Payer: Aetna Commercial |
$12,310.93
|
| Rate for Payer: Aetna Medicare |
$6,687.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,414.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,037.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,037.75
|
| Rate for Payer: BCBS Complete |
$3,618.92
|
| Rate for Payer: BCBS MAPPO |
$6,430.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,639.18
|
| Rate for Payer: BCN Commercial |
$4,639.18
|
| Rate for Payer: BCN Medicare Advantage |
$6,430.20
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cofinity Commercial |
$12,455.77
|
| Rate for Payer: Cofinity Commercial |
$10,138.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,586.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,430.20
|
| Rate for Payer: Healthscope Commercial |
$13,035.10
|
| Rate for Payer: Mclaren Medicaid |
$3,446.59
|
| Rate for Payer: Mclaren Medicare |
$6,430.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,751.71
|
| Rate for Payer: Meridian Medicaid |
$3,618.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,394.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,310.93
|
| Rate for Payer: Nomi Health Commercial |
$13,503.42
|
| Rate for Payer: PACE Medicare |
$6,108.69
|
| Rate for Payer: PACE SWMI |
$6,430.20
|
| Rate for Payer: PHP Commercial |
$12,310.93
|
| Rate for Payer: PHP Medicare Advantage |
$6,430.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,446.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,414.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,210.02
|
| Rate for Payer: Priority Health Medicare |
$6,430.20
|
| Rate for Payer: Priority Health Narrow Network |
$16,168.02
|
| Rate for Payer: Priority Health SBD |
$9,124.57
|
| Rate for Payer: Railroad Medicare Medicare |
$6,430.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.71
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,430.20
|
| Rate for Payer: UHC Medicare Advantage |
$6,430.20
|
| Rate for Payer: UHCCP Medicaid |
$3,620.20
|
| Rate for Payer: VA VA |
$6,430.20
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$907.80
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$87.88
|
| Rate for Payer: BCN Commercial |
$87.88
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$780.71
|
| Rate for Payer: Cofinity Commercial |
$635.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$635.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$817.02
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.63
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$771.63
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Priority Health SBD |
$571.91
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$907.80
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$817.02 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.07
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$635.46
|
| Rate for Payer: Cofinity Commercial |
$780.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$635.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.24
|
| Rate for Payer: Healthscope Commercial |
$817.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.63
|
| Rate for Payer: PHP Commercial |
$771.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.07
|
| Rate for Payer: Priority Health SBD |
$571.91
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
OP
|
$3,251.25
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$965.26
|
| Rate for Payer: BCN Commercial |
$965.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$2,796.08
|
| Rate for Payer: Cofinity Commercial |
$2,275.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,275.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.09
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
IP
|
$3,251.25
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,048.29 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$2,275.88
|
| Rate for Payer: Cofinity Commercial |
$2,796.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,275.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.31
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
OP
|
$3,096.23
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$2,631.80
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.84
|
| Rate for Payer: BCN Commercial |
$1,662.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Cofinity Commercial |
$2,167.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$2,786.61
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$2,631.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$1,950.62
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.60
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
IP
|
$3,096.23
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,950.62 |
| Max. Negotiated Rate |
$2,786.61 |
| Rate for Payer: Aetna Commercial |
$2,631.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.55
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,167.36
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Healthscope Commercial |
$2,786.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: PHP Commercial |
$2,631.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health SBD |
$1,950.62
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
OP
|
$3,096.23
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$2,631.80
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$965.26
|
| Rate for Payer: BCN Commercial |
$965.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Cofinity Commercial |
$2,167.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,786.61
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$2,631.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,950.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.29
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
IP
|
$3,096.23
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,950.62 |
| Max. Negotiated Rate |
$2,786.61 |
| Rate for Payer: Aetna Commercial |
$2,631.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.55
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,167.36
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Healthscope Commercial |
$2,786.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: PHP Commercial |
$2,631.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health SBD |
$1,950.62
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.40
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$15.16
|
| Rate for Payer: BCN Commercial |
$15.16
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.18
|
| Rate for Payer: Mclaren Medicare |
$17.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$25.68
|
| Rate for Payer: PACE Medicare |
$16.26
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.62
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.10
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Core |
$1,076.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Exchange |
$1,076.40
|
| Rate for Payer: UHC Medicare Advantage |
$17.12
|
| Rate for Payer: UHCCP Medicaid |
$9.64
|
| Rate for Payer: VA VA |
$17.12
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
