|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,867.19
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,436.33 |
| Max. Negotiated Rate |
$3,480.47 |
| Rate for Payer: Aetna Commercial |
$3,287.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,513.67
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cofinity Advantage |
$2,707.03
|
| Rate for Payer: Cofinity Commercial |
$3,325.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,093.75
|
| Rate for Payer: Healthscope Commercial |
$3,480.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,287.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,900.39
|
| Rate for Payer: PHP Commercial |
$3,287.11
|
| Rate for Payer: Priority Health SBD |
$2,436.33
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,867.19
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.76 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Commercial |
$3,287.11
|
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,513.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.76
|
| Rate for Payer: BCN Commercial |
$1,664.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cofinity Advantage |
$2,707.03
|
| Rate for Payer: Cofinity Commercial |
$3,325.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,093.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$3,480.47
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,287.11
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,900.39
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$3,287.11
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health SBD |
$2,436.33
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
IP
|
$1,228.49
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.95 |
| Max. Negotiated Rate |
$1,105.64 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cofinity Advantage |
$859.94
|
| Rate for Payer: Cofinity Commercial |
$1,056.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.79
|
| Rate for Payer: Healthscope Commercial |
$1,105.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.37
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$773.95
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
OP
|
$1,228.49
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.60 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$396.60
|
| Rate for Payer: BCN Commercial |
$396.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cofinity Advantage |
$859.94
|
| Rate for Payer: Cofinity Commercial |
$1,056.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$1,105.64
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.37
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$773.95
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CONVEX WAFER
|
Facility
|
IP
|
$58.18
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$52.36 |
| Rate for Payer: Aetna Commercial |
$49.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.82
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.45
|
| Rate for Payer: Priority Health SBD |
$36.65
|
|
|
HC CONVEX WAFER
|
Facility
|
OP
|
$58.18
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$52.36 |
| Rate for Payer: Aetna Commercial |
$49.45
|
| Rate for Payer: Aetna Medicare |
$29.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.82
|
| Rate for Payer: BCBS Complete |
$23.27
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.45
|
| Rate for Payer: Priority Health SBD |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Core |
$30.31
|
| Rate for Payer: UHC Exchange |
$22.86
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.74
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health SBD |
$30.76
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.74
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.74
|
| Rate for Payer: UHC Core |
$25.44
|
| Rate for Payer: UHC Exchange |
$19.19
|
|
|
HC COOK PIGTAIL
|
Facility
|
IP
|
$477.69
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.94 |
| Max. Negotiated Rate |
$429.92 |
| Rate for Payer: Aetna Commercial |
$406.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.50
|
| Rate for Payer: Cash Price |
$382.15
|
| Rate for Payer: Cofinity Advantage |
$334.38
|
| Rate for Payer: Cofinity Commercial |
$410.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.15
|
| Rate for Payer: Healthscope Commercial |
$429.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.27
|
| Rate for Payer: PHP Commercial |
$406.04
|
| Rate for Payer: Priority Health SBD |
$300.94
|
|
|
HC COOK PIGTAIL
|
Facility
|
OP
|
$477.69
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.73 |
| Max. Negotiated Rate |
$429.92 |
| Rate for Payer: Aetna Commercial |
$406.04
|
| Rate for Payer: Aetna Medicare |
$238.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.50
|
| Rate for Payer: BCBS Complete |
$191.08
|
| Rate for Payer: Cash Price |
$382.15
|
| Rate for Payer: Cofinity Advantage |
$334.38
|
| Rate for Payer: Cofinity Commercial |
$410.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.15
|
| Rate for Payer: Healthscope Commercial |
$429.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.27
|
| Rate for Payer: PHP Commercial |
$406.04
|
| Rate for Payer: Priority Health SBD |
$300.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.50
|
| Rate for Payer: UHC Core |
$248.88
|
| Rate for Payer: UHC Exchange |
$187.73
|
|
|
HC COOLIEF RF PROBE
|
Facility
|
IP
|
$1,950.75
|
|
| Hospital Charge Code |
27200355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,228.97 |
| Max. Negotiated Rate |
$1,755.67 |
| Rate for Payer: Aetna Commercial |
$1,658.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.99
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cofinity Advantage |
$1,365.53
|
| Rate for Payer: Cofinity Commercial |
$1,677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,560.60
|
| Rate for Payer: Healthscope Commercial |
$1,755.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,658.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,463.06
|
| Rate for Payer: PHP Commercial |
$1,658.14
|
| Rate for Payer: Priority Health SBD |
$1,228.97
|
|
|
HC COOLIEF RF PROBE
|
Facility
|
OP
|
$1,950.75
|
|
| Hospital Charge Code |
27200355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.64 |
| Max. Negotiated Rate |
$1,755.67 |
| Rate for Payer: Aetna Commercial |
$1,658.14
|
| Rate for Payer: Aetna Medicare |
$975.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.99
|
| Rate for Payer: BCBS Complete |
$780.30
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cofinity Advantage |
$1,365.53
|
| Rate for Payer: Cofinity Commercial |
$1,677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,560.60
|
| Rate for Payer: Healthscope Commercial |
$1,755.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,560.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,658.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,463.06
|
| Rate for Payer: PHP Commercial |
$1,658.14
|
| Rate for Payer: Priority Health SBD |
$1,228.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.99
|
| Rate for Payer: UHC Core |
$1,016.34
|
| Rate for Payer: UHC Exchange |
$766.64
|
|
|
HC COPPER SERUM
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.51
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.24
|
| Rate for Payer: BCN Commercial |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Advantage |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.41
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$6.49
|
| Rate for Payer: Mclaren Medicare |
$12.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$13.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$18.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PACE Medicare |
$11.79
|
| Rate for Payer: PACE SWMI |
$12.41
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.41
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Priority Health Tiered Network |
$9.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.62
|
| Rate for Payer: UHC Core |
$18.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.41
|
| Rate for Payer: UHC Exchange |
$18.62
|
| Rate for Payer: UHC Medicaid |
$6.49
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$12.41
|
|
|
HC COPPER SERUM
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Advantage |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC COPPER URINE
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC COPPER URINE
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.51
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.24
|
| Rate for Payer: BCN Commercial |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.41
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Mclaren Medicaid |
$6.49
|
| Rate for Payer: Mclaren Medicare |
$12.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$13.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$18.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PACE Medicare |
$11.79
|
| Rate for Payer: PACE SWMI |
$12.41
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: PHP Medicare Advantage |
$12.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.41
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: Priority Health Tiered Network |
$9.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.62
|
| Rate for Payer: UHC Core |
$18.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.41
|
| Rate for Payer: UHC Exchange |
$18.62
|
| Rate for Payer: UHC Medicaid |
$6.49
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$12.41
|
|
|
HC CORDIS CATHETER
|
Facility
|
IP
|
$200.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.35 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
|
|
HC CORDIS CATHETER
|
Facility
|
OP
|
$200.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.82 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: BCBS Complete |
$80.22
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.36
|
| Rate for Payer: UHC Core |
$104.49
|
| Rate for Payer: UHC Exchange |
$78.82
|
|
|
HC COREWELL DRUG ANALYSIS
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$93.21 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Advantage |
$67.49
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.74
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC COREWELL DRUG ANALYSIS
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.67
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Advantage |
$67.49
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: Priority Health SBD |
$60.74
|
|
|
HC COREWELL DRUG ANALYSIS ALCOHOL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC COREWELL DRUG ANALYSIS ALCOHOL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC CORN IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC CORN IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| 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 |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| 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 |
$16.32
|
| 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 CORN POLLEN IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
