|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$104.39 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$123.05
|
| Rate for Payer: BCN Commercial |
$123.05
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Cofinity Commercial |
$348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$313.66
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.39
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$313.66 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.62
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$348.51
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health SBD |
$313.66
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$225.95 |
| Max. Negotiated Rate |
$322.78 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.12
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$251.06
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Healthscope Commercial |
$322.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health SBD |
$225.95
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$40.88
|
| Rate for Payer: BCN Commercial |
$40.88
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Cofinity Commercial |
$251.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$322.78
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$225.95
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.36
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health SBD |
$122.16
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| 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 |
$26.44
|
| Rate for Payer: BCN Commercial |
$26.44
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| 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 |
$164.82
|
| 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 |
$164.82
|
| 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 |
$126.04
|
| 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 |
$122.16
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.60
|
| 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 CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health SBD |
$38.01
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$9,331.20 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| 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 |
$14.21
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$22.35
|
| Rate for Payer: BCN Commercial |
$22.35
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Mclaren Medicaid |
$13.53
|
| 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 |
$14.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: Nomi Health Commercial |
$37.88
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.98
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health Narrow Network |
$20.78
|
| Rate for Payer: Priority Health SBD |
$38.01
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.30
|
| Rate for Payer: UHC Core |
$9,331.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.25
|
| Rate for Payer: UHC Exchange |
$9,331.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.25
|
| Rate for Payer: UHCCP Medicaid |
$14.22
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.60
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$40.49
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health SBD |
$36.44
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.60
|
| 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 |
$15.36
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: BCN Commercial |
$24.17
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$40.49
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Mclaren Medicaid |
$14.63
|
| 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 |
$15.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Medicare |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow Network |
$21.84
|
| Rate for Payer: Priority Health SBD |
$36.44
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.76
|
| Rate for Payer: UHC Core |
$4,320.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.30
|
| Rate for Payer: UHC Exchange |
$4,320.00
|
| Rate for Payer: UHC Medicare Advantage |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$15.37
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
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 |
$5,135.00 |
| 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 Commercial |
$3,993.88
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,993.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Healthscope Commercial |
$5,135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.61
|
| Rate for Payer: Priority Health SBD |
$3,594.50
|
|
|
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 |
$5,135.00 |
| 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 Commercial |
$3,993.88
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,993.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Healthscope Commercial |
$5,135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.61
|
| Rate for Payer: Priority Health SBD |
$3,594.50
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
IP
|
$3,501.78
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,206.12 |
| Max. Negotiated Rate |
$3,151.60 |
| Rate for Payer: Aetna Commercial |
$2,976.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.16
|
| Rate for Payer: Cash Price |
$2,801.42
|
| Rate for Payer: Cofinity Commercial |
$2,451.25
|
| Rate for Payer: Cofinity Commercial |
$3,011.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,451.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,801.42
|
| Rate for Payer: Healthscope Commercial |
$3,151.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,976.51
|
| Rate for Payer: PHP Commercial |
$2,976.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.16
|
| Rate for Payer: Priority Health SBD |
$2,206.12
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
OP
|
$3,501.78
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,151.60 |
| Rate for Payer: Aetna Commercial |
$2,976.51
|
| Rate for Payer: Aetna Medicare |
$1,750.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.16
|
| Rate for Payer: BCBS Complete |
$1,400.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$2,801.42
|
| Rate for Payer: Cash Price |
$2,801.42
|
| Rate for Payer: Cofinity Commercial |
$2,451.25
|
| Rate for Payer: Cofinity Commercial |
$3,011.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,451.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,801.42
|
| Rate for Payer: Healthscope Commercial |
$3,151.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,976.51
|
| Rate for Payer: PHP Commercial |
$2,976.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.16
|
| Rate for Payer: Priority Health SBD |
$2,206.12
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
OP
|
$148.17
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$133.35 |
| Rate for Payer: Aetna Commercial |
$125.94
|
| Rate for Payer: Aetna Medicare |
$74.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.31
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$118.54
|
| Rate for Payer: Cash Price |
$118.54
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Cofinity Commercial |
$127.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.54
|
| Rate for Payer: Healthscope Commercial |
$133.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.94
|
| Rate for Payer: PHP Commercial |
$125.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.31
|
| Rate for Payer: Priority Health SBD |
$93.35
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
IP
|
$148.17
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$133.35 |
| Rate for Payer: Aetna Commercial |
$125.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.31
|
| Rate for Payer: Cash Price |
$118.54
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Cofinity Commercial |
$127.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.54
|
| Rate for Payer: Healthscope Commercial |
$133.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.94
|
| Rate for Payer: PHP Commercial |
$125.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.31
|
| Rate for Payer: Priority Health SBD |
$93.35
|
|
|
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 Commercial |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.97
|
| 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: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.33
|
| Rate for Payer: Priority Health SBD |
$499.47
|
|
|
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 Commercial |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.97
|
| 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: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.33
|
| Rate for Payer: Priority Health SBD |
$499.47
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
OP
|
$1,532.09
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.84 |
| Max. Negotiated Rate |
$1,378.88 |
| Rate for Payer: Aetna Commercial |
$1,302.28
|
| Rate for Payer: Aetna Medicare |
$766.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.86
|
| Rate for Payer: BCBS Complete |
$612.84
|
| Rate for Payer: Cash Price |
$1,225.67
|
| Rate for Payer: Cofinity Commercial |
$1,072.46
|
| Rate for Payer: Cofinity Commercial |
$1,317.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,072.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.67
|
| Rate for Payer: Healthscope Commercial |
$1,378.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,302.28
|
| Rate for Payer: PHP Commercial |
$1,302.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.86
|
| Rate for Payer: Priority Health SBD |
$965.22
|
|
