|
HC COOK PIGTAIL
|
Facility
|
OP
|
$468.32
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$421.49 |
| Rate for Payer: Aetna Commercial |
$398.07
|
| Rate for Payer: Aetna Medicare |
$234.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.41
|
| Rate for Payer: BCBS Complete |
$187.33
|
| Rate for Payer: Cash Price |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$327.82
|
| Rate for Payer: Cofinity Commercial |
$402.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.66
|
| Rate for Payer: Healthscope Commercial |
$421.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.07
|
| Rate for Payer: PHP Commercial |
$398.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.41
|
| Rate for Payer: Priority Health SBD |
$295.04
|
|
|
HC COOLIEF RF PROBE
|
Facility
|
OP
|
$1,912.50
|
|
| Hospital Charge Code |
27200355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Aetna Commercial |
$1,625.62
|
| Rate for Payer: Aetna Medicare |
$956.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.12
|
| Rate for Payer: BCBS Complete |
$765.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cofinity Commercial |
$1,338.75
|
| Rate for Payer: Cofinity Commercial |
$1,644.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,338.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Commercial |
$1,721.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,625.62
|
| Rate for Payer: PHP Commercial |
$1,625.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,243.12
|
| Rate for Payer: Priority Health SBD |
$1,204.88
|
|
|
HC COOLIEF RF PROBE
|
Facility
|
IP
|
$1,912.50
|
|
| Hospital Charge Code |
27200355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,204.88 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Aetna Commercial |
$1,625.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.12
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cofinity Commercial |
$1,338.75
|
| Rate for Payer: Cofinity Commercial |
$1,644.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,338.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Commercial |
$1,721.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,625.62
|
| Rate for Payer: PHP Commercial |
$1,625.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,243.12
|
| Rate for Payer: Priority Health SBD |
$1,204.88
|
|
|
HC COPPER SERUM
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| 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 |
$6.98
|
| Rate for Payer: BCBS MAPPO |
$12.41
|
| Rate for Payer: BCN Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.41
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$6.65
|
| 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 |
$6.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: PACE Medicare |
$11.79
|
| Rate for Payer: PACE SWMI |
$12.41
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$12.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.41
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: VA VA |
$12.41
|
|
|
HC COPPER SERUM
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC COPPER URINE
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
|
|
HC COPPER URINE
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
30100171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| 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 |
$6.98
|
| Rate for Payer: BCBS MAPPO |
$12.41
|
| Rate for Payer: BCN Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.41
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Mclaren Medicaid |
$6.65
|
| 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 |
$6.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PACE Medicare |
$11.79
|
| Rate for Payer: PACE SWMI |
$12.41
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.41
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: VA VA |
$12.41
|
|
|
HC CORDIS CATHETER
|
Facility
|
OP
|
$196.62
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$176.96 |
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna Medicare |
$98.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: BCBS Complete |
$78.65
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.30
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health SBD |
$123.87
|
|
|
HC CORDIS CATHETER
|
Facility
|
IP
|
$196.62
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$176.96 |
| Rate for Payer: Aetna Commercial |
$167.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.80
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$169.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.30
|
| Rate for Payer: Healthscope Commercial |
$176.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.13
|
| Rate for Payer: PHP Commercial |
$167.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.80
|
| Rate for Payer: Priority Health SBD |
$123.87
|
|
|
HC COREWELL DRUG ANALYSIS
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
|
|
HC COREWELL DRUG ANALYSIS
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| 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 |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC COREWELL DRUG ANALYSIS ALCOHOL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC COREWELL DRUG ANALYSIS ALCOHOL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC CORN IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC CORN IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| 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 |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| 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 |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 CORN POLLEN IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| 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 |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| 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 |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 CORN POLLEN IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC CORO ANGIOS W RHC
|
Facility
|
IP
|
$8,964.41
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,647.58 |
| Max. Negotiated Rate |
$8,067.97 |
| Rate for Payer: Aetna Commercial |
$7,619.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,826.87
|
| Rate for Payer: Cash Price |
$7,171.53
|
| Rate for Payer: Cofinity Commercial |
$6,275.09
|
| Rate for Payer: Cofinity Commercial |
$7,709.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,275.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,171.53
|
| Rate for Payer: Healthscope Commercial |
$8,067.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,619.75
|
| Rate for Payer: PHP Commercial |
$7,619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,826.87
|
| Rate for Payer: Priority Health SBD |
$5,647.58
|
|
|
HC CORO ANGIOS W RHC
|
Facility
|
OP
|
$8,964.41
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$8,830.06 |
| Rate for Payer: Aetna Commercial |
$7,619.75
|
| Rate for Payer: Aetna Medicare |
$3,262.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,826.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$7,171.53
|
| Rate for Payer: Cash Price |
$7,171.53
|
| Rate for Payer: Cofinity Commercial |
$7,709.39
|
| Rate for Payer: Cofinity Commercial |
$6,275.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,275.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,171.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$8,067.97
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,619.75
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$7,619.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,826.87
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health SBD |
$5,647.58
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,830.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,766.07
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC CORO/CABG ANGIOS W RHC
|
Facility
|
IP
|
$7,111.94
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
48100016
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,480.52 |
| Max. Negotiated Rate |
$6,400.75 |
| Rate for Payer: Aetna Commercial |
$6,045.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,622.76
|
| Rate for Payer: Cash Price |
$5,689.55
|
| Rate for Payer: Cofinity Commercial |
$4,978.36
|
| Rate for Payer: Cofinity Commercial |
$6,116.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,978.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,689.55
|
| Rate for Payer: Healthscope Commercial |
$6,400.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,045.15
|
| Rate for Payer: PHP Commercial |
$6,045.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,622.76
|
| Rate for Payer: Priority Health SBD |
$4,480.52
|
|
|
HC CORO/CABG ANGIOS W RHC
|
Facility
|
OP
|
$7,111.94
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
48100016
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$8,830.06 |
| Rate for Payer: Aetna Commercial |
$6,045.15
|
| Rate for Payer: Aetna Medicare |
$3,262.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,622.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$5,689.55
|
| Rate for Payer: Cash Price |
$5,689.55
|
| Rate for Payer: Cofinity Commercial |
$6,116.27
|
| Rate for Payer: Cofinity Commercial |
$4,978.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,978.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,689.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$6,400.75
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,045.15
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$6,045.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,622.76
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health SBD |
$4,480.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,830.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,766.07
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC CORONARY ANGIOS ONLY
|
Facility
|
IP
|
$7,550.37
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,756.73 |
| Max. Negotiated Rate |
$6,795.33 |
| Rate for Payer: Aetna Commercial |
$6,417.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,907.74
|
| Rate for Payer: Cash Price |
$6,040.30
|
| Rate for Payer: Cofinity Commercial |
$5,285.26
|
| Rate for Payer: Cofinity Commercial |
$6,493.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,285.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,040.30
|
| Rate for Payer: Healthscope Commercial |
$6,795.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,417.81
|
| Rate for Payer: PHP Commercial |
$6,417.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,907.74
|
| Rate for Payer: Priority Health SBD |
$4,756.73
|
|
|
HC CORONARY ANGIOS ONLY
|
Facility
|
OP
|
$7,550.37
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$8,830.06 |
| Rate for Payer: Aetna Commercial |
$6,417.81
|
| Rate for Payer: Aetna Medicare |
$3,262.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,907.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$6,040.30
|
| Rate for Payer: Cash Price |
$6,040.30
|
| Rate for Payer: Cofinity Commercial |
$6,493.32
|
| Rate for Payer: Cofinity Commercial |
$5,285.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,285.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,040.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$6,795.33
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,417.81
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$6,417.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,907.74
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health SBD |
$4,756.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,830.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,766.07
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC CORONARY CRITICAL CARE R&B
|
Facility
|
IP
|
$6,337.46
|
|
| Hospital Charge Code |
21000001
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$3,992.60 |
| Max. Negotiated Rate |
$5,703.71 |
| Rate for Payer: Aetna Commercial |
$5,386.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,119.35
|
| Rate for Payer: Cash Price |
$5,069.97
|
| Rate for Payer: Cofinity Commercial |
$4,436.22
|
| Rate for Payer: Cofinity Commercial |
$5,450.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,436.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,069.97
|
| Rate for Payer: Healthscope Commercial |
$5,703.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,386.84
|
| Rate for Payer: PHP Commercial |
$5,386.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,119.35
|
| Rate for Payer: Priority Health SBD |
$3,992.60
|
|
|
HC CORONARY SINUS CATHETER
|
Facility
|
IP
|
$1,561.51
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$983.75 |
| Max. Negotiated Rate |
$1,405.36 |
| Rate for Payer: Aetna Commercial |
$1,327.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.98
|
| Rate for Payer: Cash Price |
$1,249.21
|
| Rate for Payer: Cofinity Commercial |
$1,093.06
|
| Rate for Payer: Cofinity Commercial |
$1,342.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,093.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.21
|
| Rate for Payer: Healthscope Commercial |
$1,405.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.28
|
| Rate for Payer: PHP Commercial |
$1,327.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.98
|
| Rate for Payer: Priority Health SBD |
$983.75
|
|
