|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$425.18
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$382.66 |
| Rate for Payer: Aetna Commercial |
$361.40
|
| Rate for Payer: Aetna Medicare |
$212.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.37
|
| Rate for Payer: BCBS Complete |
$170.07
|
| Rate for Payer: Cash Price |
$340.14
|
| Rate for Payer: Cofinity Advantage |
$297.63
|
| Rate for Payer: Cofinity Commercial |
$365.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.14
|
| Rate for Payer: Healthscope Commercial |
$382.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.88
|
| Rate for Payer: PHP Commercial |
$361.40
|
| Rate for Payer: Priority Health SBD |
$267.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.37
|
| Rate for Payer: UHC Core |
$221.52
|
| Rate for Payer: UHC Exchange |
$167.10
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
OP
|
$286.11
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.97
|
| Rate for Payer: UHC Core |
$149.06
|
| Rate for Payer: UHC Exchange |
$112.44
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
IP
|
$286.11
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC CRUTCHES
|
Facility
|
IP
|
$129.23
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$116.31 |
| Rate for Payer: Aetna Commercial |
$109.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.00
|
| Rate for Payer: Cash Price |
$103.38
|
| Rate for Payer: Cofinity Advantage |
$90.46
|
| Rate for Payer: Cofinity Commercial |
$111.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.38
|
| Rate for Payer: Healthscope Commercial |
$116.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.92
|
| Rate for Payer: PHP Commercial |
$109.85
|
| Rate for Payer: Priority Health SBD |
$81.41
|
|
|
HC CRUTCHES
|
Facility
|
OP
|
$129.23
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$116.31 |
| Rate for Payer: Aetna Commercial |
$109.85
|
| Rate for Payer: Aetna Medicare |
$64.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.00
|
| Rate for Payer: BCBS Complete |
$51.69
|
| Rate for Payer: Cash Price |
$103.38
|
| Rate for Payer: Cofinity Advantage |
$90.46
|
| Rate for Payer: Cofinity Commercial |
$111.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.38
|
| Rate for Payer: Healthscope Commercial |
$116.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.92
|
| Rate for Payer: PHP Commercial |
$109.85
|
| Rate for Payer: Priority Health SBD |
$81.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.00
|
| Rate for Payer: UHC Core |
$67.33
|
| Rate for Payer: UHC Exchange |
$50.79
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
OP
|
$12,685.18
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,612.20 |
| Max. Negotiated Rate |
$34,252.33 |
| Rate for Payer: Aetna Commercial |
$10,782.40
|
| Rate for Payer: Aetna Medicare |
$11,015.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,245.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,612.20
|
| Rate for Payer: BCN Commercial |
$4,612.20
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Cash Price |
$10,148.14
|
| Rate for Payer: Cash Price |
$10,148.14
|
| Rate for Payer: Cash Price |
$10,148.14
|
| Rate for Payer: Cofinity Advantage |
$8,879.63
|
| Rate for Payer: Cofinity Commercial |
$10,909.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,148.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Healthscope Commercial |
$11,416.66
|
| Rate for Payer: Mclaren Medicaid |
$5,539.41
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$11,121.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,782.40
|
| Rate for Payer: Nomi Health Commercial |
$31,774.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,513.89
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Commercial |
$10,782.40
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,252.33
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health SBD |
$7,991.66
|
| Rate for Payer: Priority Health Tiered Network |
$27,401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: VA VA |
$10,591.61
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
IP
|
$12,685.18
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,991.66 |
| Max. Negotiated Rate |
$11,416.66 |
| Rate for Payer: Aetna Commercial |
$10,782.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,245.37
|
| Rate for Payer: Cash Price |
$10,148.14
|
| Rate for Payer: Cofinity Advantage |
$8,879.63
|
| Rate for Payer: Cofinity Commercial |
$10,909.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,148.14
|
| Rate for Payer: Healthscope Commercial |
$11,416.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,782.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,513.89
|
| Rate for Payer: PHP Commercial |
$10,782.40
|
| Rate for Payer: Priority Health SBD |
$7,991.66
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
OP
|
$10,740.37
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,015.30 |
| Max. Negotiated Rate |
$34,252.33 |
| Rate for Payer: Aetna Commercial |
$9,129.31
|
| Rate for Payer: Aetna Medicare |
$11,015.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,981.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,015.30
|
| Rate for Payer: BCN Commercial |
$3,015.30
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Cash Price |
$8,592.30
|
| Rate for Payer: Cash Price |
$8,592.30
|
| Rate for Payer: Cash Price |
$8,592.30
|
| Rate for Payer: Cofinity Advantage |
$7,518.26
|
| Rate for Payer: Cofinity Commercial |
$9,236.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,592.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Healthscope Commercial |
$9,666.33
|
| Rate for Payer: Mclaren Medicaid |
$5,539.41
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$11,121.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,129.31
|
| Rate for Payer: Nomi Health Commercial |
$31,774.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,055.28
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Commercial |
$9,129.31
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,252.33
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health SBD |
$6,766.43
|
| Rate for Payer: Priority Health Tiered Network |
$27,401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: VA VA |
$10,591.61
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
IP
|
$10,740.37
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,766.43 |
| Max. Negotiated Rate |
$9,666.33 |
| Rate for Payer: Aetna Commercial |
$9,129.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,981.24
|
| Rate for Payer: Cash Price |
$8,592.30
|
| Rate for Payer: Cofinity Advantage |
$7,518.26
|
| Rate for Payer: Cofinity Commercial |
$9,236.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,592.30
|
| Rate for Payer: Healthscope Commercial |
$9,666.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,129.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,055.28
|
| Rate for Payer: PHP Commercial |
$9,129.31
|
| Rate for Payer: Priority Health SBD |
$6,766.43
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
IP
|
$11,109.39
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,998.92 |
| Max. Negotiated Rate |
$9,998.45 |
| Rate for Payer: Aetna Commercial |
$9,442.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,221.10
|
| Rate for Payer: Cash Price |
$8,887.51
|
| Rate for Payer: Cofinity Advantage |
$7,776.57
|
| Rate for Payer: Cofinity Commercial |
$9,554.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,887.51
|
| Rate for Payer: Healthscope Commercial |
$9,998.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,442.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,332.04
|
| Rate for Payer: PHP Commercial |
$9,442.98
|
| Rate for Payer: Priority Health SBD |
$6,998.92
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
OP
|
$11,109.39
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Commercial |
$9,442.98
|
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,221.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$8,887.51
|
| Rate for Payer: Cash Price |
$8,887.51
|
| Rate for Payer: Cofinity Advantage |
$7,776.57
|
| Rate for Payer: Cofinity Commercial |
$9,554.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,887.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$9,998.45
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,442.98
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,332.04
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$9,442.98
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health SBD |
$6,998.92
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,221.10
|
| Rate for Payer: UHC Core |
$5,787.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$4,365.99
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
IP
|
$3,597.50
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,266.43 |
| Max. Negotiated Rate |
$3,237.75 |
| Rate for Payer: Aetna Commercial |
$3,057.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.38
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cofinity Advantage |
$2,518.25
|
| Rate for Payer: Cofinity Commercial |
$3,093.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.00
|
| Rate for Payer: Healthscope Commercial |
$3,237.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,057.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,698.12
|
| Rate for Payer: PHP Commercial |
$3,057.88
|
| Rate for Payer: Priority Health SBD |
$2,266.43
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
OP
|
$3,597.50
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,413.82 |
| Max. Negotiated Rate |
$3,237.75 |
| Rate for Payer: Aetna Commercial |
$3,057.88
|
| Rate for Payer: Aetna Medicare |
$1,798.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.38
|
| Rate for Payer: BCBS Complete |
$1,439.00
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cofinity Advantage |
$2,518.25
|
| Rate for Payer: Cofinity Commercial |
$3,093.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.00
|
| Rate for Payer: Healthscope Commercial |
$3,237.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,878.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,057.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,698.12
|
| Rate for Payer: PHP Commercial |
$3,057.88
|
| Rate for Payer: Priority Health SBD |
$2,266.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,338.38
|
| Rate for Payer: UHC Core |
$1,874.30
|
| Rate for Payer: UHC Exchange |
$1,413.82
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,343.84
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,279.13 |
| Max. Negotiated Rate |
$7,509.46 |
| Rate for Payer: Aetna Commercial |
$7,092.26
|
| Rate for Payer: Aetna Medicare |
$4,171.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,423.50
|
| Rate for Payer: BCBS Complete |
$3,337.54
|
| Rate for Payer: Cash Price |
$6,675.07
|
| Rate for Payer: Cofinity Advantage |
$5,840.69
|
| Rate for Payer: Cofinity Commercial |
$7,175.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,675.07
|
| Rate for Payer: Healthscope Commercial |
$7,509.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,675.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,092.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,257.88
|
| Rate for Payer: PHP Commercial |
$7,092.26
|
| Rate for Payer: Priority Health SBD |
$5,256.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,423.50
|
| Rate for Payer: UHC Core |
$4,347.14
|
| Rate for Payer: UHC Exchange |
$3,279.13
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,343.84
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,256.62 |
| Max. Negotiated Rate |
$7,509.46 |
| Rate for Payer: Aetna Commercial |
$7,092.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,423.50
|
| Rate for Payer: Cash Price |
$6,675.07
|
| Rate for Payer: Cofinity Advantage |
$5,840.69
|
| Rate for Payer: Cofinity Commercial |
$7,175.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,675.07
|
| Rate for Payer: Healthscope Commercial |
$7,509.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,092.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,257.88
|
| Rate for Payer: PHP Commercial |
$7,092.26
|
| Rate for Payer: Priority Health SBD |
$5,256.62
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
OP
|
$12,517.61
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,919.42 |
| Max. Negotiated Rate |
$11,265.85 |
| Rate for Payer: Aetna Commercial |
$10,639.97
|
| Rate for Payer: Aetna Medicare |
$6,258.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,136.45
|
| Rate for Payer: BCBS Complete |
$5,007.04
|
| Rate for Payer: Cash Price |
$10,014.09
|
| Rate for Payer: Cofinity Advantage |
$8,762.33
|
| Rate for Payer: Cofinity Commercial |
$10,765.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,014.09
|
| Rate for Payer: Healthscope Commercial |
$11,265.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,014.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,639.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,388.21
|
| Rate for Payer: PHP Commercial |
$10,639.97
|
| Rate for Payer: Priority Health SBD |
$7,886.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,136.45
|
| Rate for Payer: UHC Core |
$6,521.67
|
| Rate for Payer: UHC Exchange |
$4,919.42
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
IP
|
$12,517.61
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,886.09 |
| Max. Negotiated Rate |
$11,265.85 |
| Rate for Payer: Aetna Commercial |
$10,639.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,136.45
|
| Rate for Payer: Cash Price |
$10,014.09
|
| Rate for Payer: Cofinity Advantage |
$8,762.33
|
| Rate for Payer: Cofinity Commercial |
$10,765.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,014.09
|
| Rate for Payer: Healthscope Commercial |
$11,265.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,639.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,388.21
|
| Rate for Payer: PHP Commercial |
$10,639.97
|
| Rate for Payer: Priority Health SBD |
$7,886.09
|
|
|
HC CRYOGLOBULINS
|
Facility
|
IP
|
$20.17
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.11
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.14
|
| Rate for Payer: Healthscope Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.13
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: Priority Health SBD |
$12.71
|
|
|
HC CRYOGLOBULINS
|
Facility
|
OP
|
$20.17
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$6.89
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$18.15
|
| Rate for Payer: Mclaren Medicaid |
$3.38
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.13
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$12.71
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
IP
|
$25.32
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$22.79 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.46
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cofinity Advantage |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$22.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.99
|
| Rate for Payer: PHP Commercial |
$21.52
|
| Rate for Payer: Priority Health SBD |
$15.95
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
OP
|
$25.32
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$22.79 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.08
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cofinity Advantage |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$22.79
|
| Rate for Payer: Mclaren Medicaid |
$7.40
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: Meridian Medicaid |
$14.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.52
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.99
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$21.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.14
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health SBD |
$15.95
|
| Rate for Payer: Priority Health Tiered Network |
$11.31
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.21
|
| Rate for Payer: UHC Core |
$21.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.14
|
| Rate for Payer: UHC Exchange |
$21.21
|
| Rate for Payer: UHC Medicaid |
$7.40
|
| Rate for Payer: UHCCP Medicaid |
$7.40
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$6.89
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$3.38
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
OP
|
$146.02
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$226.94 |
| Rate for Payer: Aetna Commercial |
$124.12
|
| Rate for Payer: Aetna Medicare |
$72.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.71
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$70.17
|
| Rate for Payer: BCBS Trust/PPO |
$176.71
|
| Rate for Payer: BCN Commercial |
$176.71
|
| Rate for Payer: BCN Medicare Advantage |
$70.17
|
| Rate for Payer: Cash Price |
$116.82
|
| Rate for Payer: Cash Price |
$116.82
|
| Rate for Payer: Cofinity Advantage |
$102.21
|
| Rate for Payer: Cofinity Commercial |
$125.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.17
|
| Rate for Payer: Healthscope Commercial |
$131.42
|
| Rate for Payer: Mclaren Medicaid |
$36.70
|
| Rate for Payer: Mclaren Medicare |
$70.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.68
|
| Rate for Payer: Meridian Medicaid |
$73.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.12
|
| Rate for Payer: Nomi Health Commercial |
$210.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.52
|
| Rate for Payer: PACE Medicare |
$66.66
|
| Rate for Payer: PACE SWMI |
$70.17
|
| Rate for Payer: PHP Commercial |
$124.12
|
| Rate for Payer: PHP Medicare Advantage |
$70.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$70.17
|
| Rate for Payer: Priority Health SBD |
$91.99
|
| Rate for Payer: Priority Health Tiered Network |
$181.55
|
| Rate for Payer: Railroad Medicare Medicare |
$70.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.91
|
| Rate for Payer: UHC Core |
$76.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.17
|
| Rate for Payer: UHC Exchange |
$57.39
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$70.17
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
IP
|
$146.02
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.99 |
| Max. Negotiated Rate |
$131.42 |
| Rate for Payer: Aetna Commercial |
$124.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.91
|
| Rate for Payer: Cash Price |
$116.82
|
| Rate for Payer: Cofinity Advantage |
$102.21
|
| Rate for Payer: Cofinity Commercial |
$125.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.82
|
| Rate for Payer: Healthscope Commercial |
$131.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.52
|
| Rate for Payer: PHP Commercial |
$124.12
|
| Rate for Payer: Priority Health SBD |
$91.99
|
|
